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

Dutch Hepato Biliary Audit Group; Sebastiaan Ceuppens; Pim B Olthof; Arthur K E Elfrink; Stijn Franssen; Rutger-Jan Swijnenburg; Joost M Klaase; Maarten W Nijkamp; Frederik J H Hoogwater; Andries E Braat; Jeroen Hagendoorn; Wouter J M Derksen; Peter B van den Boezem; Paul D Gobardhan; Marcel den Dulk; Maxime J L Dewulf; Mike S L Liem; Wouter K G Leclercq; Eric J T Belt; Koert F D Kuhlmann; Niels F M Kok; Hendrik A Marsman; Dirk Jan Grünhagen; Joris I Erdmann; Bas Groot Koerkamp

doi:10.1016/j.gassur.2025.102064

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

Dutch Hepato Biliary Audit Group, Sebastiaan Ceuppens, Pim B Olthof, Arthur K E Elfrink, Stijn Franssen, Rutger-Jan Swijnenburg, Joost M Klaase, Maarten W Nijkamp, Frederik J H Hoogwater, Andries E Braat, Jeroen Hagendoorn, Wouter J M Derksen, Peter B van den Boezem, Paul D Gobardhan, Marcel den Dulk, Maxime J L Dewulf, Mike S L Liem, Wouter K G Leclercq, Eric J T Belt, Koert F D KuhlmannNiels F M Kok, Hendrik A Marsman, Dirk Jan Grünhagen, Joris I Erdmann, Bas Groot Koerkamp

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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.

Originele taal-2	English
Artikelnummer	102064
Aantal pagina's	7
Tijdschrift	Journal of Gastrointestinal Surgery
Volume	29
Nummer van het tijdschrift	6
Vroegere onlinedatum	17-apr.-2025
DOI's	https://doi.org/10.1016/j.gassur.2025.102064
Status	Published - jun.-2025

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10.1016/j.gassur.2025.102064Licentie: CC BY

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Dutch Hepato Biliary Audit Group, Ceuppens, S., Olthof, P. B., Elfrink, A. K. E., Franssen, S., Swijnenburg, R.-J., Klaase, J. M., Nijkamp, M. W., Hoogwater, F. J. H., Braat, A. E., Hagendoorn, J., Derksen, W. J. M., van den Boezem, P. B., Gobardhan, P. D., den Dulk, M., Dewulf, M. J. L., Liem, M. S. L., Leclercq, W. K. G., Belt, E. J. T., ... Koerkamp, B. G. (2025). Preoperative risk score for 90-day mortality following major liver resection. Journal of Gastrointestinal Surgery, 29(6), Artikel 102064. https://doi.org/10.1016/j.gassur.2025.102064

@article{2b474eb5ffd048d988d6bdb9bd6a46b1,

title = "Preoperative risk score for 90-day mortality following major liver resection",

abstract = "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.",

author = "\{Dutch Hepato Biliary Audit Group\} and Sebastiaan Ceuppens and Olthof, \{Pim B\} and Elfrink, \{Arthur K E\} and Stijn Franssen and Rutger-Jan Swijnenburg and Klaase, \{Joost M\} and Nijkamp, \{Maarten W\} and Hoogwater, \{Frederik J H\} and Braat, \{Andries E\} and Jeroen Hagendoorn and Derksen, \{Wouter J M\} and \{van den Boezem\}, \{Peter B\} and Gobardhan, \{Paul D\} and \{den Dulk\}, Marcel and Dewulf, \{Maxime J L\} and Liem, \{Mike S L\} and Leclercq, \{Wouter K G\} and Belt, \{Eric J T\} and Kuhlmann, \{Koert F D\} and Kok, \{Niels F M\} and Marsman, \{Hendrik A\} and \{Jan Gr{\"u}nhagen\}, Dirk and Erdmann, \{Joris I\} and Koerkamp, \{Bas Groot\}",

note = "Copyright {\textcopyright} 2025. Published by Elsevier Inc.",

year = "2025",

month = jun,

doi = "10.1016/j.gassur.2025.102064",

language = "English",

volume = "29",

journal = "Journal of Gastrointestinal Surgery",

issn = "1091-255X",

publisher = "Springer",

number = "6",

}

Dutch Hepato Biliary Audit Group, Ceuppens, S, Olthof, PB, Elfrink, AKE, Franssen, S, Swijnenburg, R-J, Klaase, JM , Nijkamp, MW , Hoogwater, FJH, Braat, AE, Hagendoorn, J, Derksen, WJM, van den Boezem, PB, Gobardhan, PD, den Dulk, M, Dewulf, MJL, Liem, MSL, Leclercq, WKG, Belt, EJT, Kuhlmann, KFD, Kok, NFM, Marsman, HA, Jan Grünhagen, D, Erdmann, JI & Koerkamp, BG 2025, 'Preoperative risk score for 90-day mortality following major liver resection', Journal of Gastrointestinal Surgery, vol. 29, nr. 6, 102064. https://doi.org/10.1016/j.gassur.2025.102064

TY - JOUR

T1 - Preoperative risk score for 90-day mortality following major liver resection

AU - Dutch Hepato Biliary Audit Group

AU - Ceuppens, Sebastiaan

AU - Olthof, Pim B

AU - Elfrink, Arthur K E

AU - Franssen, Stijn

AU - Swijnenburg, Rutger-Jan

AU - Klaase, Joost M

AU - Nijkamp, Maarten W

AU - Hoogwater, Frederik J H

AU - Braat, Andries E

AU - Hagendoorn, Jeroen

AU - Derksen, Wouter J M

AU - van den Boezem, Peter B

AU - Gobardhan, Paul D

AU - den Dulk, Marcel

AU - Dewulf, Maxime J L

AU - Liem, Mike S L

AU - Leclercq, Wouter K G

AU - Belt, Eric J T

AU - Kuhlmann, Koert F D

AU - Kok, Niels F M

AU - Marsman, Hendrik A

AU - Jan Grünhagen, Dirk

AU - Erdmann, Joris I

AU - Koerkamp, Bas Groot

PY - 2025/6

Y1 - 2025/6

N2 - 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.

AB - 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.

U2 - 10.1016/j.gassur.2025.102064

DO - 10.1016/j.gassur.2025.102064

M3 - Article

C2 - 40253050

SN - 1091-255X

VL - 29

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

IS - 6

M1 - 102064

ER -

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

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