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Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection

Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection
Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection

Background: previous studies have demonstrated that patient, surgical, tumour and operative variables affect the complexity of laparoscopic liver resections. However, current difficulty scoring systems address only tumour factors. The aim of this study was to develop and validate a predictive model for the risk of intraoperative complications during laparoscopic liver resections. 

Methods: the prospectively maintained databases of seven European tertiary referral liver centres were compiled. Data from two-thirds of the patients were used for development and one-third for validation of the model. Intraoperative complications were based on a modified Satava classification. Using the methodology of the Framingham Heart Study, developed to identify risk factors that contribute to the development of cardiovascular disease, factors found to predict intraoperative complications independently were assigned points, and grouped into low-, moderate-, high- and extremely high-risk groups based on the likelihood of intraoperative complications. 

Results: a total of 2856 patients were included. Neoadjuvant chemotherapy, lesion type and size, classification of resection and previous open liver resection were found to be independent predictors of intraoperative complications. Patients with intraoperative complications had a longer duration of hospital stay (5 versus 4 days; P < 0·001), higher complication rates (32·5 versus 15·5 per cent; P < 0·001), and higher 30-day (3·0 versus 0·3 per cent; P < 0·001) and 90-day (3·8 versus 0·8 per cent; P < 0·001) mortality rates than those who did not. The model was able to predict intraoperative complications (area under the receiver operating characteristic (ROC) curve (AUC) 0·677, 95 per cent c.i. 0·647 to 0·706) as well as postoperative 90-day mortality (AUC 0·769, 0·681 to 0·858). 

Conclusion: this comprehensive scoring system, based on patient, surgical and tumour factors, and developed and validated using a large multicentre European database, helped estimate the risk of intraoperative complications.

0007-1323
1182-1191
Halls, M. C.
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Berardi, G.
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Cipriani, F.
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Barkhatov, L.
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Lainas, P.
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Harris, S.
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D'Hondt, M.
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Rotellar, F.
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Dagher, I.
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Aldrighetti, L.
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Troisi, R. I.
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Edwin, B.
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Abu Hilal, M.
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Halls, M. C.
1074982b-1829-40be-863a-25a38d63ad19
Berardi, G.
b7b2a81f-94f0-49d4-9b3e-958c5854d826
Cipriani, F.
d8020a7d-e8ac-49f9-a7cc-572ed0e01883
Barkhatov, L.
034d9b4d-8047-4c1d-85cb-c88cdd76b6b5
Lainas, P.
99e111a5-af78-4c43-b433-71657e239860
Harris, S.
19ea097b-df15-4f0f-be19-8ac42c190028
D'Hondt, M.
dad5077e-c50f-45dc-a433-f5e327566bb6
Rotellar, F.
a7de9d5e-65f1-49fa-99e9-d8ba1e46bd55
Dagher, I.
312c6f59-9764-45d0-a050-cb27a3100f23
Aldrighetti, L.
bab36581-c535-4f90-970d-0a982fe7a244
Troisi, R. I.
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Edwin, B.
b04994d3-928a-49ad-8bdf-183c7e7a08d2
Abu Hilal, M.
384e1c60-8519-4eed-8e92-91775aad4c47

Halls, M. C., Berardi, G., Cipriani, F., Barkhatov, L., Lainas, P., Harris, S., D'Hondt, M., Rotellar, F., Dagher, I., Aldrighetti, L., Troisi, R. I., Edwin, B. and Abu Hilal, M. (2018) Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. British Journal of Surgery, 105 (9), 1182-1191. (doi:10.1002/bjs.10821).

Record type: Article

Abstract

Background: previous studies have demonstrated that patient, surgical, tumour and operative variables affect the complexity of laparoscopic liver resections. However, current difficulty scoring systems address only tumour factors. The aim of this study was to develop and validate a predictive model for the risk of intraoperative complications during laparoscopic liver resections. 

Methods: the prospectively maintained databases of seven European tertiary referral liver centres were compiled. Data from two-thirds of the patients were used for development and one-third for validation of the model. Intraoperative complications were based on a modified Satava classification. Using the methodology of the Framingham Heart Study, developed to identify risk factors that contribute to the development of cardiovascular disease, factors found to predict intraoperative complications independently were assigned points, and grouped into low-, moderate-, high- and extremely high-risk groups based on the likelihood of intraoperative complications. 

Results: a total of 2856 patients were included. Neoadjuvant chemotherapy, lesion type and size, classification of resection and previous open liver resection were found to be independent predictors of intraoperative complications. Patients with intraoperative complications had a longer duration of hospital stay (5 versus 4 days; P < 0·001), higher complication rates (32·5 versus 15·5 per cent; P < 0·001), and higher 30-day (3·0 versus 0·3 per cent; P < 0·001) and 90-day (3·8 versus 0·8 per cent; P < 0·001) mortality rates than those who did not. The model was able to predict intraoperative complications (area under the receiver operating characteristic (ROC) curve (AUC) 0·677, 95 per cent c.i. 0·647 to 0·706) as well as postoperative 90-day mortality (AUC 0·769, 0·681 to 0·858). 

Conclusion: this comprehensive scoring system, based on patient, surgical and tumour factors, and developed and validated using a large multicentre European database, helped estimate the risk of intraoperative complications.

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The Southampton Laparoscopic Liver Score Accepted Manuscript - Accepted Manuscript
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Accepted/In Press date: 13 December 2017
e-pub ahead of print date: 8 May 2018
Published date: 1 August 2018

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Local EPrints ID: 423034
URI: https://eprints.soton.ac.uk/id/eprint/423034
ISSN: 0007-1323
PURE UUID: 7abf40a4-b644-4ef6-b269-4b5c09035bfe

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Date deposited: 10 Aug 2018 16:30
Last modified: 14 Mar 2019 05:04

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Contributors

Author: M. C. Halls
Author: G. Berardi
Author: F. Cipriani
Author: L. Barkhatov
Author: P. Lainas
Author: S. Harris
Author: M. D'Hondt
Author: F. Rotellar
Author: I. Dagher
Author: L. Aldrighetti
Author: R. I. Troisi
Author: B. Edwin
Author: M. Abu Hilal

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