Abstract
BackgroundRisk prediction techniques commonly used in liver surgery include the American Society of Anesthesiologists (ASA) grading, Charlson Comorbidity Index (CCI) and cardiopulmonary exercise tests (CPET). This study compares the utility of these techniques along with the number of segments resected as predictive tools in liver surgery.MethodsA review of a unit database of patients undergoing liver resection between February 2008 and January 2015 was undertaken. Patient demographics, ASA, CCI and CPET variables were recorded along with resection size. Clavien-Dindo grade III–V complications were used as a composite outcome in analyses. Association between predictive variables and outcome was assessed by univariate and multivariate techniques.ResultsOne hundred and seventy-two resections in 168 patients were identified. Grade III–V complications occurred after 42 (24.4%) liver resections. In univariate analysis of CPET variables, ventilatory equivalents for CO2 (VEqCO2) was associated with outcome. CCI score, but not ASA grade, was also associated with outcome. In multivariate analysis, the odds ratio of developing grade III–V complications for incremental increases in VEqCO2, CCI and number of liver segments resected were 1.09, 1.49 and 2.94, respectively.ConclusionsOf the techniques evaluated, resection size provides the simplest and most discriminating predictor of significant complications following liver surgery.
Highlights
Risk prediction techniques commonly used in liver surgery include the American Society of Anesthesiologists (ASA) grading, Charlson Comorbidity Index (CCI) and cardiopulmonary exercise tests (CPET)
The ASA grade has been shown to influence the development of postoperative complications after liver resection (Belghiti et al 2000), and CCI has been assessed in the prediction of short-term outcomes (Schroeder et al 2006)
ventilatory equivalents for CO2 (VEqCO2) results were unavailable in five patients
Summary
Risk prediction techniques commonly used in liver surgery include the American Society of Anesthesiologists (ASA) grading, Charlson Comorbidity Index (CCI) and cardiopulmonary exercise tests (CPET). This study compares the utility of these techniques along with the number of segments resected as predictive tools in liver surgery. A number of techniques are commonly used preoperatively to estimate risk including the American Society of Anesthesiology (ASA) grade, Charlson Comorbidity Index (CCI) and Cardiopulmonary Exercise Tests (CPET). The ASA grade has been shown to influence the development of postoperative complications after liver resection (Belghiti et al 2000), and CCI has been assessed in the prediction of short-term outcomes (Schroeder et al 2006). Data on the use of CPET before liver surgery is conflicting, with one study showing a useful correlation with complications (Junejo et al 2012) and another showing only minimal association (Dunne et al 2014). None of the tools takes into account the extent of the proposed operation, and no comparison between the techniques has been undertaken
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