Determinants of outcome following hepatectomy by evaluating prognostic significance of different scoring systems

Abstract

Introduction: Present study evaluated factors mentioned in scoring systems such as Child Turcott Pugh (CTP) score, Model of End Stage Liver Disease (MELD) score.A modified score based on CTP scoring system but eliminating two subjective parameters (encephalopathy and ascites) and including proThrombin time, Albumin, serum total Bilirubin : TAB score with similar scoring system was formulated. Methods: Present study was conducted prospectively at a tertiary care hospital from October 2015 to August 2017. All patients were evaluated with the same preoperative evaluation protocol. Post operative morbidity was measured by using the Clavien-Dindo Classification of Surgical Complications. Duration of follow up was 30 days from the date of surgery. Results: Total 51 patients were included in the study. Median MELD, TAB and CTP score values were 7.86 (6-18) and 3.20 (3-6), 5.24 (5-8) respectively. Overall morbidity associated with hepatic resection was 43.2%. Univariate analysis showed that jaundice at presentation (p=0.029), intra operative blood loss (p=0.009) and duration of surgery (p=0.001) were significantly associated with post operative complications leading to significant increase in total hospital stay (p =0.002). Post operative hepatic failure (PHF) was seen in 4 (7.8%) patients. Post operative mortality was observed in two (3.92%) patients. Conclusions: MELD score of ≥13mg/dl preoperatively was significantly associated with increased risk for any postoperative complications, 30-day mortality and increased length of hospital stay. TAB score did not prove to be helpful in correctly identifying the patients at risk for developing complications or mortality.