Preoperative risk score for 90-day mortality following major liver resection

BACKGROUND: Major liver resection is frequently performed for primary and secondary liver tumours. However, 90-day mortality rates can exceed 10% in high risk patients. The aim of this study was to develop a preoperative risk score for postoperative mortality after major liver resection.

METHODS: All major liver resection between 2014 and 2019 in two Dutch tertiary referral centers were identified. A validation cohort consisted of all consecutive patients who underwent a major liver resection in the nationwide Dutch Hepato-Biliary Audit (DHBA) from 2014 until 2020. Multivariate logistic regression was used to identify prognostic factors and develop a mortality risk score.

RESULTS: Major liver resection was performed in 513 patients of whom 238 (46.4%) had a primary liver cancer and in 148 (28.8%) patients a hepatico-jejunostomy was performed. 90-day mortality occurred in 56 patients (10.8%). Mortality was independently predicted by 5 risk factors: age ≥ 65 years, diabetes type 2, diagnosis of primary liver cancer, ASA ≥3, and extended hemihepatectomy. A risk score with one point assigned to each risk factor showed good discrimination (AUC 0.77; 95% CI, 0.71 to 0.83). The predicted 90-day mortality was 3.5% for low risk (0 or 1 points; 53.8% of all patients), 11.1% for intermediate risk (2 points; 25.3%), and 29.7% for high risk patients (3 to 5 points; 20.9%). External validation in the nationwide cohort with 1617 patients showed similar concordance (AUC 0.69; 95% CI, 0.64 to 0.75).

CONCLUSION: The proposed and validated risk score can aid in shared decision making.