A risk model to predict 90-day mortality among patients undergoing hepatic resection

Omar Hyder, Carlo Pulitano, Amin Firoozmand, Rebecca Dodson, Christopher L. Wolfgang, Michael A. Choti, Luca Aldrighetti, Timothy M. Pawlik

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Abstract

Background: Reliable criteria to predict mortality after hepatectomy remain poorly defined. We sought to identify factors associated with 90-day mortality, as well as validate the "50-50" and peak bilirubin of >7 mg/dL prediction rules for mortality after liver resection. In addition, we propose a novel integer-based score for 90-day mortality using a large cohort of patients. Study Design: Data from 2,056 patients who underwent liver resection at 2 major hepatobiliary centers between 1990 and 2011 were identified. Perioperative laboratory data, as well as surgical and postoperative details, were analyzed to identify factors associated with liver-related 90-day death. Results: Indications for liver resection included colorectal metastasis (39%), hepatocellular carcinoma (19%), benign mass (17%), or noncolorectal metastasis (14%). Most patients had normal underlying liver parenchyma (71%) and resection involved ≥3 segments (36%). Overall morbidity and mortality were 19% and 2%, respectively. Only 1 patient fulfilled the 50-50 criteria; this patient survived and was discharged on day 8. Twenty patients had a peak bilirubin concentration >7 mg/dL and 5 died within 90 days; the sensitivity and specificity of the >7-mg/dL rule were 25% and 99.3%, respectively, but overall accuracy was poor (area under the curve 0.574). Factors associated with 90-day mortality included international normalized ratio (odds ratio = 11.87), bilirubin (odds ratio = 1.16), and serum creatinine (odds ratio = 1.87) on postoperative day 3, as well as grade of postoperative complications (odds ratio = 5.08; all p < 0.05). Integer values were assigned to each factor to develop a model that predicted 90-day mortality (area under the curve 0.89). A score of ≥11 points had a sensitivity and specificity of 83.3% and 98.8%, respectively. Conclusions: The 50-50 and bilirubin >7-mg/dL rules were not accurate in predicting 90-day mortality. Rather, a composite integer-based risk score based on postoperative day 3 international normalized ratio, bilirubin, creatinine, and complication grade more accurately predicted 90-day mortality after hepatectomy.

Original languageEnglish (US)
Pages (from-to)1049-1056
Number of pages8
JournalJournal of the American College of Surgeons
Volume216
Issue number6
DOIs
StatePublished - Jun 2013

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Mortality
Liver
Bilirubin
Odds Ratio
International Normalized Ratio
Hepatectomy
Creatinine
Neoplasm Metastasis
Area Under Curve
Hepatocellular Carcinoma
Morbidity
Sensitivity and Specificity
Serum

ASJC Scopus subject areas

  • Surgery

Cite this

Hyder, O., Pulitano, C., Firoozmand, A., Dodson, R., Wolfgang, C. L., Choti, M. A., ... Pawlik, T. M. (2013). A risk model to predict 90-day mortality among patients undergoing hepatic resection. Journal of the American College of Surgeons, 216(6), 1049-1056. https://doi.org/10.1016/j.jamcollsurg.2013.01.004

A risk model to predict 90-day mortality among patients undergoing hepatic resection. / Hyder, Omar; Pulitano, Carlo; Firoozmand, Amin; Dodson, Rebecca; Wolfgang, Christopher L.; Choti, Michael A.; Aldrighetti, Luca; Pawlik, Timothy M.

In: Journal of the American College of Surgeons, Vol. 216, No. 6, 06.2013, p. 1049-1056.

Research output: Contribution to journalArticle

Hyder, O, Pulitano, C, Firoozmand, A, Dodson, R, Wolfgang, CL, Choti, MA, Aldrighetti, L & Pawlik, TM 2013, 'A risk model to predict 90-day mortality among patients undergoing hepatic resection', Journal of the American College of Surgeons, vol. 216, no. 6, pp. 1049-1056. https://doi.org/10.1016/j.jamcollsurg.2013.01.004
Hyder, Omar ; Pulitano, Carlo ; Firoozmand, Amin ; Dodson, Rebecca ; Wolfgang, Christopher L. ; Choti, Michael A. ; Aldrighetti, Luca ; Pawlik, Timothy M. / A risk model to predict 90-day mortality among patients undergoing hepatic resection. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 6. pp. 1049-1056.
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abstract = "Background: Reliable criteria to predict mortality after hepatectomy remain poorly defined. We sought to identify factors associated with 90-day mortality, as well as validate the {"}50-50{"} and peak bilirubin of >7 mg/dL prediction rules for mortality after liver resection. In addition, we propose a novel integer-based score for 90-day mortality using a large cohort of patients. Study Design: Data from 2,056 patients who underwent liver resection at 2 major hepatobiliary centers between 1990 and 2011 were identified. Perioperative laboratory data, as well as surgical and postoperative details, were analyzed to identify factors associated with liver-related 90-day death. Results: Indications for liver resection included colorectal metastasis (39{\%}), hepatocellular carcinoma (19{\%}), benign mass (17{\%}), or noncolorectal metastasis (14{\%}). Most patients had normal underlying liver parenchyma (71{\%}) and resection involved ≥3 segments (36{\%}). Overall morbidity and mortality were 19{\%} and 2{\%}, respectively. Only 1 patient fulfilled the 50-50 criteria; this patient survived and was discharged on day 8. Twenty patients had a peak bilirubin concentration >7 mg/dL and 5 died within 90 days; the sensitivity and specificity of the >7-mg/dL rule were 25{\%} and 99.3{\%}, respectively, but overall accuracy was poor (area under the curve 0.574). Factors associated with 90-day mortality included international normalized ratio (odds ratio = 11.87), bilirubin (odds ratio = 1.16), and serum creatinine (odds ratio = 1.87) on postoperative day 3, as well as grade of postoperative complications (odds ratio = 5.08; all p < 0.05). Integer values were assigned to each factor to develop a model that predicted 90-day mortality (area under the curve 0.89). A score of ≥11 points had a sensitivity and specificity of 83.3{\%} and 98.8{\%}, respectively. Conclusions: The 50-50 and bilirubin >7-mg/dL rules were not accurate in predicting 90-day mortality. Rather, a composite integer-based risk score based on postoperative day 3 international normalized ratio, bilirubin, creatinine, and complication grade more accurately predicted 90-day mortality after hepatectomy.",
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AU - Aldrighetti, Luca

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N2 - Background: Reliable criteria to predict mortality after hepatectomy remain poorly defined. We sought to identify factors associated with 90-day mortality, as well as validate the "50-50" and peak bilirubin of >7 mg/dL prediction rules for mortality after liver resection. In addition, we propose a novel integer-based score for 90-day mortality using a large cohort of patients. Study Design: Data from 2,056 patients who underwent liver resection at 2 major hepatobiliary centers between 1990 and 2011 were identified. Perioperative laboratory data, as well as surgical and postoperative details, were analyzed to identify factors associated with liver-related 90-day death. Results: Indications for liver resection included colorectal metastasis (39%), hepatocellular carcinoma (19%), benign mass (17%), or noncolorectal metastasis (14%). Most patients had normal underlying liver parenchyma (71%) and resection involved ≥3 segments (36%). Overall morbidity and mortality were 19% and 2%, respectively. Only 1 patient fulfilled the 50-50 criteria; this patient survived and was discharged on day 8. Twenty patients had a peak bilirubin concentration >7 mg/dL and 5 died within 90 days; the sensitivity and specificity of the >7-mg/dL rule were 25% and 99.3%, respectively, but overall accuracy was poor (area under the curve 0.574). Factors associated with 90-day mortality included international normalized ratio (odds ratio = 11.87), bilirubin (odds ratio = 1.16), and serum creatinine (odds ratio = 1.87) on postoperative day 3, as well as grade of postoperative complications (odds ratio = 5.08; all p < 0.05). Integer values were assigned to each factor to develop a model that predicted 90-day mortality (area under the curve 0.89). A score of ≥11 points had a sensitivity and specificity of 83.3% and 98.8%, respectively. Conclusions: The 50-50 and bilirubin >7-mg/dL rules were not accurate in predicting 90-day mortality. Rather, a composite integer-based risk score based on postoperative day 3 international normalized ratio, bilirubin, creatinine, and complication grade more accurately predicted 90-day mortality after hepatectomy.

AB - Background: Reliable criteria to predict mortality after hepatectomy remain poorly defined. We sought to identify factors associated with 90-day mortality, as well as validate the "50-50" and peak bilirubin of >7 mg/dL prediction rules for mortality after liver resection. In addition, we propose a novel integer-based score for 90-day mortality using a large cohort of patients. Study Design: Data from 2,056 patients who underwent liver resection at 2 major hepatobiliary centers between 1990 and 2011 were identified. Perioperative laboratory data, as well as surgical and postoperative details, were analyzed to identify factors associated with liver-related 90-day death. Results: Indications for liver resection included colorectal metastasis (39%), hepatocellular carcinoma (19%), benign mass (17%), or noncolorectal metastasis (14%). Most patients had normal underlying liver parenchyma (71%) and resection involved ≥3 segments (36%). Overall morbidity and mortality were 19% and 2%, respectively. Only 1 patient fulfilled the 50-50 criteria; this patient survived and was discharged on day 8. Twenty patients had a peak bilirubin concentration >7 mg/dL and 5 died within 90 days; the sensitivity and specificity of the >7-mg/dL rule were 25% and 99.3%, respectively, but overall accuracy was poor (area under the curve 0.574). Factors associated with 90-day mortality included international normalized ratio (odds ratio = 11.87), bilirubin (odds ratio = 1.16), and serum creatinine (odds ratio = 1.87) on postoperative day 3, as well as grade of postoperative complications (odds ratio = 5.08; all p < 0.05). Integer values were assigned to each factor to develop a model that predicted 90-day mortality (area under the curve 0.89). A score of ≥11 points had a sensitivity and specificity of 83.3% and 98.8%, respectively. Conclusions: The 50-50 and bilirubin >7-mg/dL rules were not accurate in predicting 90-day mortality. Rather, a composite integer-based risk score based on postoperative day 3 international normalized ratio, bilirubin, creatinine, and complication grade more accurately predicted 90-day mortality after hepatectomy.

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