Preoperative model for end-stage liver disease score as a predictor for posthemihepatectomy complications

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Abstract

Background

As diagnostic techniques advance and surgical outcomes improve, the rate of utilization of liver hemihepatectomy for various indications will continue to increase.

Objectives

To explore the preoperative predictors of liver hemihepatectomy postoperative complications.

Patients and methods

This study included retrospective analysis of the clinical data of patients who underwent either liver hemihepatectomy or extended hemihepatectomy at Georg August University Hospital-Goettingen for the period 2002–2012. The outcomes were either postoperative complications or death of the patient (within 3 months from the end of the operation). Modified classification of surgical complications was adopted in the current study. The preoperative model for end-stage liver disease (MELD) score, aspartate aminotransferase, creatinine, international normalized ratio, and bilirubin in addition to the demographic characteristics of the patients and intraoperative blood loss were analyzed as predictive for postliver hemihepatectomy complications.

Results

The study included 144 patients who underwent liver hemiheptectomy or extended hemihepatectomy through the study period (2002–2012). Postoperative complications were reported among patients out of 144 (52.1%). The most frequent complications were pleural effusion (26.7%), biliary leakage (21.3%), wound dehiscence (13.3%), ascites, and intra-abdominal abscess (6.7%). Death was reported among six patients of those who developed complications (8%). There were four cases of hepatic cirrhosis (one macroscopic and three microscopic). Two of the microscopic cases had no postoperative complications (grade 1), whereas one case had grade 3a and the macroscopic case had postoperative complication grade 1. Their MELD scores ranged between 6 and 10 preoperatively. The association between preoperative MELD score and development of posthemihepatetomy was statistically significant, P=0.002. Death was reported in six cases, yielding a mortality rate of 4.17%. MELD score preoperatively was the only significant predictor for postoperative complications.

Conclusion

The rate of complications following hemihepatectomy remains high, with 52.1% of the patients in the current study having at least one complication as all of our patients underwent either hemihepatectomy or extended hemihepatectomy. A 4.17% mortality rate has been reported. A higher preoperative MELD score is the only significant predictor for the development of posthemihepatectomy complications.

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