BACKGROUND: Reliable criteria to predict mortality after hepatectomy remain poorly defined. We sought to identify factors associated with 90-day mortality, as well as validate the "50-50" and peak bilirubin of >7 mg/dL prediction rules for mortality after liver resection. In addition, we propose a novel integer-based score for 90-day mortality using a large cohort of patients. STUDY DESIGN: Data from 2,056 patients who underwent liver resection at 2 major hepatobiliary centers between 1990 and 2011 were identified. Perioperative laboratory data, as well as surgical and postoperative details, were analyzed to identify factors associated with liver-related 90-day death. RESULTS: Indications for liver resection included colorectal metastasis (39%), hepatocellular carcinoma (19%), benign mass (17%), or noncolorectal metastasis (14%). Most patients had normal underlying liver parenchyma (71%) and resection involved ≥3 segments (36%). Overall morbidity and mortality were 19% and 2%, respectively. Only 1 patient fulfilled the 50-50 criteria; this patient survived and was discharged on day 8. Twenty patients had a peak bilirubin concentration >7 mg/dL and 5 died within 90 days; the sensitivity and specificity of the >7-mg/dL rule were 25% and 99.3%, respectively, but overall accuracy was poor (area under the curve 0.574). Factors associated with 90-day mortality included international normalized ratio (odds ratio = 11.87), bilirubin (odds ratio = 1.16), and serum creatinine (odds ratio = 1.87) on postoperative day 3, as well as grade of postoperative complications (odds ratio = 5.08; all p < 0.05). Integer values were assigned to each factor to develop a model that predicted 90-day mortality (area under the curve 0.89). A score of ≥11 points had a sensitivity and specificity of 83.3% and 98.8%, respectively. CONCLUSIONS: The 50-50 and bilirubin >7-mg/dL rules were not accurate in predicting 90-day mortality. Rather, a composite integer-based risk score based on postoperative day 3 international normalized ratio, bilirubin, creatinine, and complication grade more accurately predicted 90-day mortality after hepatectomy.
BACKGROUND: Reliable criteria to predict mortality after hepatectomy remain poorly defined. We sought to identify factors associated with 90-day mortality, as well as validate the "50-50" and peak bilirubin of >7 mg/dL prediction rules for mortality after liver resection. In addition, we propose a novel integer-based score for 90-day mortality using a large cohort of patients. STUDY DESIGN: Data from 2,056 patients who underwent liver resection at 2 major hepatobiliary centers between 1990 and 2011 were identified. Perioperative laboratory data, as well as surgical and postoperative details, were analyzed to identify factors associated with liver-related 90-day death. RESULTS: Indications for liver resection included colorectal metastasis (39%), hepatocellular carcinoma (19%), benign mass (17%), or noncolorectal metastasis (14%). Most patients had normal underlying liver parenchyma (71%) and resection involved ≥3 segments (36%). Overall morbidity and mortality were 19% and 2%, respectively. Only 1 patient fulfilled the 50-50 criteria; this patient survived and was discharged on day 8. Twenty patients had a peak bilirubin concentration >7 mg/dL and 5 died within 90 days; the sensitivity and specificity of the >7-mg/dL rule were 25% and 99.3%, respectively, but overall accuracy was poor (area under the curve 0.574). Factors associated with 90-day mortality included international normalized ratio (odds ratio = 11.87), bilirubin (odds ratio = 1.16), and serum creatinine (odds ratio = 1.87) on postoperative day 3, as well as grade of postoperative complications (odds ratio = 5.08; all p < 0.05). Integer values were assigned to each factor to develop a model that predicted 90-day mortality (area under the curve 0.89). A score of ≥11 points had a sensitivity and specificity of 83.3% and 98.8%, respectively. CONCLUSIONS: The 50-50 and bilirubin >7-mg/dL rules were not accurate in predicting 90-day mortality. Rather, a composite integer-based risk score based on postoperative day 3 international normalized ratio, bilirubin, creatinine, and complication grade more accurately predicted 90-day mortality after hepatectomy.
Authors: Nuh N Rahbari; O James Garden; Robert Padbury; Mark Brooke-Smith; Michael Crawford; Rene Adam; Moritz Koch; Masatoshi Makuuchi; Ronald P Dematteo; Christopher Christophi; Simon Banting; Val Usatoff; Masato Nagino; Guy Maddern; Thomas J Hugh; Jean-Nicolas Vauthey; Paul Greig; Myrddin Rees; Yukihiro Yokoyama; Sheung Tat Fan; Yuji Nimura; Joan Figueras; Lorenzo Capussotti; Markus W Büchler; Jürgen Weitz Journal: Surgery Date: 2011-01-14 Impact factor: 3.982
Authors: Jean-Nicolas Vauthey; Timothy M Pawlik; Eddie K Abdalla; James F Arens; Rabih A Nemr; Steven H Wei; Debra L Kennamer; Lee M Ellis; Steven A Curley Journal: Ann Surg Date: 2004-05 Impact factor: 12.969
Authors: Ronnie T Poon; Sheung Tat Fan; Chung Mau Lo; Chi Leung Liu; Chi Ming Lam; Wai Key Yuen; Chun Yeung; John Wong Journal: Ann Surg Date: 2004-10 Impact factor: 12.969
Authors: William R Jarnagin; Mithat Gonen; Yuman Fong; Ronald P DeMatteo; Leah Ben-Porat; Sarah Little; Carlos Corvera; Sharon Weber; Leslie H Blumgart Journal: Ann Surg Date: 2002-10 Impact factor: 12.969
Authors: Aslam Ejaz; Gaya Spolverato; Yuhree Kim; Donald L Lucas; Brandyn Lau; Matthew Weiss; Fabian M Johnston; Marin Kheng; Marian Kheng; Kenzo Hirose; Christopher L Wolfgang; Elliott Haut; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2013-12-13 Impact factor: 3.452
Authors: Neda Amini; Yuhree Kim; Ana Wilson; Georgios Antonios Margonis; Cecilia G Ethun; George Poultsides; Thuy Tran; Kamran Idrees; Chelsea A Isom; Ryan C Fields; Bradley Krasnick; Sharon M Weber; Ahmed Salem; Robert C G Martin; Charles Scoggins; Perry Shen; Harveshp D Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Rivfka Shenoy; Shishir K Maithel; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2016-05-05 Impact factor: 5.344