Dasari Bobby V M, Hodson James, Sutcliffe Robert P, Marudanayagam Ravi, Roberts Keith J, Abradelo Manuel, Muiesan Paolo, Mirza Darius F, Isaac John
Deptartment of HPB and Liver Transplantation surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
J Surg Oncol. 2019 Mar;119(4):472-478. doi: 10.1002/jso.25350. Epub 2019 Jan 13.
Hepatobiliary surgeons continue to expand the pool of patients undergoing liver resection using combinations of surgical and interventional procedures with chemotherapy. Improved perioperative care allows for operation on higher risk surgical patients. Postoperative outcomes, including 90-day mortality that improved over the past decade but still varies across cohorts. This study developed a preoperative risk score, on the basis significant clinical and laboratory variables, to predict 90-day mortality after hepatectomy.
All patients who underwent hepatectomy between 2011 and 2016 were included. Univariable and multivariable analyses were performed to identify the predictors of postoperative mortality and a risk score was derived and validated.
The overall 90-day mortality rate in the derivation cohort (n = 1269 patients) was 4.0% (N = 51). Increasing patient age (P < 0.001), extent of resection (P = 0.001), diabetes mellitus (P = 0.006), and low preoperative sodium (P = 0.012) were predictors of the increased 90-day mortality in the multivariable analysis. The risk model developed based on these factors had an AUROC of 0.778 (P < 0.001) and remained significant in a validation cohort of 788 patients (AUROC: 0.703, P < 0.001).
The proposed preoperative risk score to predict 90-day mortality after liver resection could be useful for appropriate counseling, optimization, and risk-adjusted assessment of surgical outcomes.
肝胆外科医生不断扩大接受肝切除术患者的范围，采用手术、介入治疗与化疗相结合的方法。围手术期护理的改善使得对手术风险较高的患者也能进行手术。术后结局，包括90天死亡率在过去十年有所改善，但在不同队列中仍存在差异。本研究基于显著的临床和实验室变量制定了术前风险评分，以预测肝切除术后的90天死亡率。
纳入2011年至2016年间接受肝切除术的所有患者。进行单变量和多变量分析以确定术后死亡率的预测因素，并得出并验证风险评分。
推导队列（n = 1269例患者）的总体90天死亡率为4.0%（N = 51）。在多变量分析中，患者年龄增加（P < 0.001）、切除范围（P = 0.001）、糖尿病（P = 0.006）和术前低钠血症（P = 0.012）是90天死亡率增加的预测因素。基于这些因素建立的风险模型的曲线下面积（AUROC）为0.778（P < 0.001），在788例患者的验证队列中仍然具有显著性（AUROC：0.703，P < 0.001）。
所提出的预测肝切除术后90天死亡率的术前风险评分可能有助于进行适当的咨询、优化以及对手术结局进行风险调整评估。
