Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard David Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Am J Surg. 2023 Jan;225(1):198-205. doi: 10.1016/j.amjsurg.2022.07.028. Epub 2022 Aug 5.
Liver resection is commonly performed for hepatic tumors, however preoperative risk stratification remains challenging. We evaluated the performance of contemporary prediction models for short-term mortality after liver resection in patients with and without cirrhosis.
This retrospective cohort study examined National Surgical Quality Improvement Program data. We included patients who underwent liver resections from 2014 to 2019. VOCAL-Penn, MELD, MELD-Na, ALBI, and Mayo risk scores were evaluated in terms of model discrimination and calibration for 30-day post-operative mortality.
A total 15,198 patients underwent liver resection, of whom 249 (1.6%) experienced 30-day post-operative mortality. The VOCAL-Penn score had the highest discrimination (area under the ROC curve [AUC] 0.74) compared to all other models. The VOCAL-Penn score similarly outperformed other models in patients with (AUC 0.70) and without (AUC 0.74) cirrhosis.
The VOCAL-Penn score demonstrated superior predictive performance for 30-day post-operative mortality after liver resection as compared to existing clinical standards.
肝切除术常用于治疗肝肿瘤，但术前风险分层仍然具有挑战性。我们评估了有无肝硬化的肝切除术后短期死亡率的现代预测模型的表现。
本回顾性队列研究分析了国家外科质量改进计划的数据。我们纳入了 2014 年至 2019 年期间接受肝切除术的患者。评估了 VOCAL-Penn、MELD、MELD-Na、ALBI 和 Mayo 风险评分在术后 30 天死亡率方面的模型区分度和校准度。
共有 15198 例患者接受了肝切除术，其中 249 例（1.6%）发生了 30 天术后死亡。与所有其他模型相比，VOCAL-Penn 评分具有最高的区分度（ROC 曲线下面积[AUC]为 0.74）。在有无肝硬化的患者中，VOCAL-Penn 评分同样优于其他模型（AUC 分别为 0.70 和 0.74）。
与现有临床标准相比，VOCAL-Penn 评分在预测肝切除术后 30 天死亡率方面表现出更好的预测性能。
