Kimura Jiro, Takagi Kosei, Umeda Yuzo, Fuji Tomokazu, Yasui Kazuya, Yamada Motohiko, Nishiyama Takeyoshi, Nagai Yasuo, Kanehira Noriyuki, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Hepatol Res. 2025 Mar;55(3):454-464. doi: 10.1111/hepr.14134. Epub 2024 Nov 2.
Although hepatectomy is a complex surgical procedure, its incidence among older patients has increased due to global aging. However, few studies have focused on the association between age and failure to rescue (FTR) posthepatectomy. This study aimed to investigate the association between age and FTR and develop a risk model for FTR following hepatectomy.
We analyzed a total of 1371 consecutive patients who underwent primary hepatectomy between July 2003 and September 2022. The patients were divided into three groups according to their age: young-old (<65 years), pre-old (65-74 years), and old group (≥75 years). Additionally, the associations among age, FTR, and risk factors for FTR were investigated. Subsequently, a risk model was developed to predict the FTR.
Of the 1371 patients, 373 (27.2%) experienced major complications, and FTR occurred in 15 patients. The older group showed a higher FTR rate (8.4%) than the young-old (1.3%) and pre-old (4.3%) groups (p = 0.03). Multivariate analyses indicated that older age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15; p = 0.045) and American Society of Anesthesiologists Physical Status score ≥3 (OR 4.35; 95% CI 1.24-15.2; p = 0.02) were independent predictive factors for FTR. The risk model exhibited an accuracy with an area under the curve of 0.80 (95% CI 0.69-0.92). Calibration plots of the model revealed a concordance index of 0.73.
This study identified an association between age, FTR, and risk factors for FTR posthepatectomy. Together, our risk model is a clinically relevant, internally validated, and useful tool for predicting FTR posthepatectomy.
尽管肝切除术是一项复杂的外科手术，但由于全球老龄化，其在老年患者中的发生率有所增加。然而，很少有研究关注年龄与肝切除术后救援失败（FTR）之间的关联。本研究旨在调查年龄与FTR之间的关联，并建立肝切除术后FTR的风险模型。
我们分析了2003年7月至2022年9月期间连续接受初次肝切除术的1371例患者。根据年龄将患者分为三组：年轻老年组（<65岁）、老年前期组（65-74岁）和老年组（≥75岁）。此外，还研究了年龄、FTR和FTR风险因素之间的关联。随后，建立了一个风险模型来预测FTR。
在1371例患者中，373例（27.2%）出现了严重并发症，15例发生了FTR。老年组的FTR发生率（8.4%）高于年轻老年组（1.3%）和老年前期组（4.3%）（p = 0.03）。多因素分析表明，年龄较大（比值比[OR] 1.07；95%置信区间[CI] 1.00-1.15；p = 0.045）和美国麻醉医师协会身体状况评分≥3（OR 4.35；95% CI 1.24-15.2；p = 0.02）是FTR的独立预测因素。该风险模型的曲线下面积为0.80（95% CI 0.69-0.92），显示出较高的准确性。模型的校准图显示一致性指数为0.73。
本研究确定了年龄、FTR和肝切除术后FTR风险因素之间的关联。总之，我们的风险模型是一种临床相关、内部验证且有助于预测肝切除术后FTR的工具。
