scholarly journals A Simple Preoperative Score to Predict Postoperative Mortality after Major Hepatectomy

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S44
Author(s):  
K. Zorbas ◽  
A. Karachristos
Keyword(s):  
Major Hepatectomy ◽  
Postoperative Mortality ◽  
Preoperative Score

Validation of the Preoperative Score to Predict Postoperative Mortality in Patients Undergoing Radical Cystectomy

2019 ◽  
Vol 5 (2) ◽  
pp. 197-200 ◽  
Author(s):  
Michael Froehner ◽  
Rainer Koch ◽  
Matthias Hübler ◽  
Ulrike Heberling ◽  
Vladimir Novotny ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Postoperative Mortality ◽  
Preoperative Score

Risk factors of hospital mortality after initial hepatic resection among patients with primary hepatocellular carcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 352-352
Author(s):  
Hong-Gui Qin ◽  
Jian-Hong Zhong ◽  
Yan-Yan Wang ◽  
Shi-Dong Lu ◽  
Bang-De Xiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Portal Hypertension ◽  
Major Hepatectomy ◽  
Postoperative Mortality ◽  
Primary Hepatocellular Carcinoma ◽  
Model Parameters ◽  
Tumor Number ◽  
Independent Risk Factors

352 Background: Hepatectomy is widely used to treat patients with hepatocellular carcinoma (HCC), even those with intermediate and advanced disease. Despite its well-demonstrated clinical efficacy in many patients, postoperative mortality is an inevitable problem. This study aims to investigate the risk factors of mortality after hepatectomy. Methods: A consecutive sample of 1518 patients with HCC who underwent initial hepatectomy from January 1, 2004 to October 31, 2013 were retrospective analyzed. Multivariate analysis to identify independent risk factors of postoperative mortality was carried out using the Cox proportional hazards model. Parameters for multivariate analyses included age, gender, tumor size, tumor number, preoperative serum albumin, alanine aminotransferase, total bilirubin, α-fetoprotein, prothrombin time, tumor capsule, macrovascular invasion, portal hypertension, diabetes mellitus, ascites, major hepatectomy, surgical time, blood loss, blood transfusion, and clamping portal hepatis time. Results: A total of 18 (1.19%) and 45 (2.96%) patients died within 30 and 90 days after hepatectomy, respectively. Multivariate analysis revealed that tumor number ( ≥ 4), macrovascular invasion, and major hepatectomy were independent risk factors of 30 and 90 days mortality, while portal hypertension was also an independent risk factor of 90 days mortality. Conclusions: Among HCC patients with tumor number equal or more than four, macrovascular invasion, portal hypertension, or underwent major hepatectomy, intensive postoperative care management are in particular.

Significance of the Effective Remnant Liver Volume in Major Hepatectomies

2005 ◽  
Vol 71 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Salvatore Gruttadauria ◽  
Fabio Vasta ◽  
Marta Ida Minervini ◽  
Tommaso Piazza ◽  
Antonio Arcadipane ◽  
...  
Keyword(s):  
Major Hepatectomy ◽  
Frozen Section ◽  
Liver Volume ◽  
Postoperative Mortality ◽  
Liver Function Tests ◽  
Chronic Viral Hepatitis ◽  
Remnant Liver ◽  
Total Liver Volume ◽  
Remnant Liver Volume ◽  
Major Hepatectomies

The aim of this study is to identify the minimum safe amount of effective remnant liver volume (ERLV) in patients undergoing a major hepatectomy. Thirty-eight consecutive major hepatectomies (resection of ≥3 Couinaud segments) performed between July 1999 and March 2004 in which a frozen section liver biopsy was obtained were included. No patient had chronic viral hepatitis, cirrhosis, or cholestasis. The total liver volume (TLV) was calculated using the Vauthey formula, and the postsurgical liver volume (PSLV) was derived by subtracting the estimated volume of liver resected from the TLV. The PSLV minus the percentage of macrovesicular steatosis as nonfunctional liver was defined as the effective remnant liver volume (ERLV). Three groups of ERLV/TLV ratios (<30%, between 30% and 60%, and >60%) were correlated with liver resection type, mortality, complications, intraoperative blood transfusions, operative time, length of hospitalization, and mean value of liver function tests in the first 5 postoperative days. Comparisons between clinical parameters were performed by Pearson χ2 test. There was significant correlation between ERLV/TLV ratios and surgical resection type ( P < 0.001), early postoperative mortality ( P < 0.01), and complications ( P < 0.003). The ERLV/TLV ratio may be a useful predictor of surgical outcome after major hepatectomy.

Preoperative Score to Predict Postoperative Mortality (POSPOM)

2016 ◽  
Vol 124 (3) ◽  
pp. 570-579 ◽  
Author(s):  
Yannick Le Manach ◽  
Gary Collins ◽  
Reitze Rodseth ◽  
Christine Le Bihan-Benjamin ◽  
Bruce Biccard ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Risk Score ◽  
Clinical Decision Making ◽  
Validation Cohort ◽  
Postoperative Mortality ◽  
Clinical Decision ◽  
Derivation Cohort ◽  
International Statistical Classification ◽  
Hospital Deaths ◽  
Preoperative Score

Abstract Background An accurate risk score able to predict in-hospital mortality in patients undergoing surgery may improve both risk communication and clinical decision making. The aim of the study was to develop and validate a surgical risk score based solely on preoperative information, for predicting in-hospital mortality. Methods From January 1, 2010, to December 31, 2010, data related to all surgeries requiring anesthesia were collected from all centers (single hospital or hospitals group) in France performing more than 500 operations in the year on patients aged 18 yr or older (n = 5,507,834). International Statistical Classification of Diseases, 10th revision codes were used to summarize the medical history of patients. From these data, the authors developed a risk score by examining 29 preoperative factors (age, comorbidities, and surgery type) in 2,717,902 patients, and then validated the risk score in a separate cohort of 2,789,932 patients. Results In the derivation cohort, there were 12,786 in-hospital deaths (0.47%; 95% CI, 0.46 to 0.48%), whereas in the validation cohort there were 14,933 in-hospital deaths (0.54%; 95% CI, 0.53 to 0.55%). Seventeen predictors were identified and included in the PreOperative Score to predict PostOperative Mortality (POSPOM). POSPOM showed good calibration and excellent discrimination for in-hospital mortality, with a c-statistic of 0.944 (95% CI, 0.943 to 0.945) in the development cohort and 0.929 (95% CI, 0.928 to 0.931) in the validation cohort. Conclusion The authors have developed and validated POSPOM, a simple risk score for the prediction of in-hospital mortality in surgical patients.

Patient Comorbidities Drive High Mortality Rates Associated with Major Liver Resections Irrespective of Hospital Volume

2020 ◽  
pp. 000313482097336
Author(s):  
Laurence P. Diggs ◽  
John G. Aversa ◽  
Timothy L. Wiemken ◽  
Sean P. Martin ◽  
Justin A. Drake ◽  
...  
Keyword(s):  
Major Hepatectomy ◽  
Care Center ◽  
Postoperative Mortality ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Patient Specific ◽  
Liver Malignancies ◽  
Perioperative Mortality ◽  
Factors Associated ◽  
Major Hepatectomies

Introduction Major hepatectomies are utilized to manage primary hepatic malignancies. Reports from high-volume centers (HVCs) with minimal perioperative mortality focus on multiple aspects of perioperative care, although patient-specific factors remain unelucidated. We identified patient factors associated with outcomes and examined whether these contribute to survival differences. Methods We queried the National Cancer Database (2006-2015) for patients with primary liver malignancies managed with major hepatectomy. Facilities were dichotomized by volume (high volume: >15 hepatectomies/year). Perioperative outcomes were compared based on patient demographic and clinical characteristics as well as center volume. Results 4263 patients were included with 78.5% receiving care in low-volume centers (LVCs). 90-day postoperative mortality was higher in LVCs vs. HVCs (12% vs. 7.5%; P < .001). Factors associated with undergoing surgery in LVCs included: living in areas with lower income ( P = .006) and education ( P < .001), having nonprivate insurance ( P < .001), residing near the care center ( P < .001), and having a comorbidity score (CDS) >1 ( P = .014). Patients with CDS ≤ 1 had higher 90-day mortality in LVCs (11.3% vs. 6.6%; P < .001) and had similar outcomes in LVCs and HVCs (15.6% vs. 13.7% P = .6). Patients with CDS > 1 were more likely to receive care in LVCs (16.3% vs. 12.7%; P < .001). Conclusion Reduced perioperative mortality following major hepatectomy in HVCs is driven by optimal management of patients with low CDS. However, nearly 1 in 5 patients who undergo major hepatectomies have a high CDS and approximately 15% of them succumb in the perioperative period irrespective of the treating centers’ experience.

scholarly journals Validation of the Preoperative Score to Predict Postoperative Mortality (POSPOM) in Germany

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245841
Author(s):  
Yannik C. Layer ◽  
Jan Menzenbach ◽  
Yonah L. Layer ◽  
Andreas Mayr ◽  
Tobias Hilbert ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Postoperative Mortality ◽  
University Hospital ◽  
Brier Score ◽  
Calibration Plot ◽  
Coding System ◽  
C Statistic ◽  
Using Data ◽  
Previous Demonstration ◽  
Preoperative Score

Background The Preoperative Score to Predict Postoperative Mortality (POSPOM) based on preoperatively available data was presented by Le Manach et al. in 2016. This prognostic model considers the kind of surgical procedure, patients' age and 15 defined comorbidities to predict the risk of postoperative in-hospital mortality. Objective of the present study was to validate POSPOM for the German healthcare coding system (G-POSPOM). Methods and findings All cases involving anaesthesia performed at the University Hospital Bonn between 2006 and 2017 were analysed retrospectively. Procedures codified according to the French Groupes Homogènes de Malades (GHM) were translated and adapted to the German Operationen- und Prozedurenschlüssel (OPS). Comorbidities were identified by the documented International Statistical Classification of Diseases (ICD-10) coding. POSPOM was calculated for the analysed patient collective using these data according to the method described by Le Manach et al. Performance of thereby adapted POSPOM was tested using c-statistic, Brier score and a calibration plot. Validation was performed using data from 199,780 surgical cases. With a mean age of 56.33 years (SD 18.59) and a proportion of 49.24% females, the overall cohort had a mean POSPOM value of 18.18 (SD 8.11). There were 4,066 in-hospital deaths, corresponding to an in-hospital mortality rate of 2.04% (95% CI 1.97 to 2.09%) in our sample. POSPOM showed a good performance with a c-statistic of 0.771 and a Brier score of 0.021. Conclusions After adapting POSPOM to the German coding system, we were able to validate the score using patient data of a German university hospital. According to previous demonstration for French patient cohorts, we observed a good correlation of POSPOM with in-hospital mortality. Therefore, further adjustments of POSPOM considering also multicentre and transnational validation should be pursued based on this proof of concept.

scholarly journals Institutional actual utilization of postoperative mortality using nationwide survey based risk calculator in patients who underwent major hepatectomy

2021 ◽  
Author(s):  
Atsushi Nanashima ◽  
Naoya Imamura ◽  
Masahide Hiyoshi ◽  
Koichi Yano ◽  
Takeomi Hamada ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
High Mortality ◽  
Major Hepatectomy ◽  
Postoperative Mortality ◽  
Nationwide Survey ◽  
Bile Leakage ◽  
Risk Calculator ◽  
Biliary Malignancy ◽  
Co Morbidity

Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database risk calculator (NCD-RC) was examined . Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies . The cut-off value for high-risk mortality was set at 5%. Patients were divided into four groups: A) no severe complications and low predictive mortality rate (woML) , B) severe complications or mortality, and low mortality rate (wML) , C) no severe complications and high mortality rate (woMH) , and D) severe complications or mortality, and high mortality rate (wMH) . Results: Morbidity higher than CD III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and two (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (p&lt;0.01). Age, elderly patients, diseases, and co-morbidity did not significantly differ among groups. Although bile leakage was common in group wML , there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and two died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.

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