Individualized risk estimation for postoperative morbidity after hepatectomy: the Humanitas score

Research output: Contribution to journalArticle

Abstract

Background Estimation of postoperative morbidity after hepatectomy remains challenging. The aim of this prospective study was to develop a surgical score to predict an individual risk of post-hepatectomy complications. Methods All consecutive patients scheduled for hepatectomy from February 2012 to September 2015 were included and randomly assigned into a derivation or validation cohort. We developed a score based on preoperative variables, and we tested them using multivariate analyses. Odds-ratio (OR) values were used to build the score. Results 340 patients were included, 240 in the derivation and 100 in the validation cohort. Multivariate analysis showed that major hepatectomy (OR = 1.62; 95% CI 1.39–3.51), liver stiffness ≥9.7 kPa (OR = 2.46; 95% CI 1.16–5.28), BILCHE score (combination of serum bilirubin and cholinesterase) ≥2 (OR = 2.76; 95% CI 0.82–4.28) and esophageal varices (OR = 1.59; 95% CI 1.51–3.61) were independent complications predictors. A 10-point scoring system was introduced. Patients with a score ≤4 did not experience complications, whereas patients with ≥7 points experienced up to 54% of complications (P < 0.001). Conclusions A new, easy and clinically reliable surgical score based on the liver stiffness, BILCHE score, type of hepatectomy, and presence of varices may be used to predict post-hepatectomy morbidity. Clinical trial number NCT02454686 (https://www.clinicaltrials.gov/).

Original languageEnglish
Pages (from-to)910-918
Number of pages9
JournalHPB
Volume19
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

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Cholinesterases
Hepatectomy
Bilirubin
Morbidity
Odds Ratio
Serum
Multivariate Analysis
Esophageal and Gastric Varices
Liver
Varicose Veins
Clinical Trials
Prospective Studies

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Individualized risk estimation for postoperative morbidity after hepatectomy : the Humanitas score. / Donadon, Matteo; Fontana, Andrea; Palmisano, Angela; Viganò, Luca; Procopio, Fabio; Cimino, Matteo; Del Fabbro, Daniele; Torzilli, Guido.

In: HPB, Vol. 19, No. 10, 01.10.2017, p. 910-918.

Research output: Contribution to journalArticle

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abstract = "Background Estimation of postoperative morbidity after hepatectomy remains challenging. The aim of this prospective study was to develop a surgical score to predict an individual risk of post-hepatectomy complications. Methods All consecutive patients scheduled for hepatectomy from February 2012 to September 2015 were included and randomly assigned into a derivation or validation cohort. We developed a score based on preoperative variables, and we tested them using multivariate analyses. Odds-ratio (OR) values were used to build the score. Results 340 patients were included, 240 in the derivation and 100 in the validation cohort. Multivariate analysis showed that major hepatectomy (OR = 1.62; 95{\%} CI 1.39–3.51), liver stiffness ≥9.7 kPa (OR = 2.46; 95{\%} CI 1.16–5.28), BILCHE score (combination of serum bilirubin and cholinesterase) ≥2 (OR = 2.76; 95{\%} CI 0.82–4.28) and esophageal varices (OR = 1.59; 95{\%} CI 1.51–3.61) were independent complications predictors. A 10-point scoring system was introduced. Patients with a score ≤4 did not experience complications, whereas patients with ≥7 points experienced up to 54{\%} of complications (P < 0.001). Conclusions A new, easy and clinically reliable surgical score based on the liver stiffness, BILCHE score, type of hepatectomy, and presence of varices may be used to predict post-hepatectomy morbidity. Clinical trial number NCT02454686 (https://www.clinicaltrials.gov/).",
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AU - Donadon, Matteo

AU - Fontana, Andrea

AU - Palmisano, Angela

AU - Viganò, Luca

AU - Procopio, Fabio

AU - Cimino, Matteo

AU - Del Fabbro, Daniele

AU - Torzilli, Guido

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N2 - Background Estimation of postoperative morbidity after hepatectomy remains challenging. The aim of this prospective study was to develop a surgical score to predict an individual risk of post-hepatectomy complications. Methods All consecutive patients scheduled for hepatectomy from February 2012 to September 2015 were included and randomly assigned into a derivation or validation cohort. We developed a score based on preoperative variables, and we tested them using multivariate analyses. Odds-ratio (OR) values were used to build the score. Results 340 patients were included, 240 in the derivation and 100 in the validation cohort. Multivariate analysis showed that major hepatectomy (OR = 1.62; 95% CI 1.39–3.51), liver stiffness ≥9.7 kPa (OR = 2.46; 95% CI 1.16–5.28), BILCHE score (combination of serum bilirubin and cholinesterase) ≥2 (OR = 2.76; 95% CI 0.82–4.28) and esophageal varices (OR = 1.59; 95% CI 1.51–3.61) were independent complications predictors. A 10-point scoring system was introduced. Patients with a score ≤4 did not experience complications, whereas patients with ≥7 points experienced up to 54% of complications (P < 0.001). Conclusions A new, easy and clinically reliable surgical score based on the liver stiffness, BILCHE score, type of hepatectomy, and presence of varices may be used to predict post-hepatectomy morbidity. Clinical trial number NCT02454686 (https://www.clinicaltrials.gov/).

AB - Background Estimation of postoperative morbidity after hepatectomy remains challenging. The aim of this prospective study was to develop a surgical score to predict an individual risk of post-hepatectomy complications. Methods All consecutive patients scheduled for hepatectomy from February 2012 to September 2015 were included and randomly assigned into a derivation or validation cohort. We developed a score based on preoperative variables, and we tested them using multivariate analyses. Odds-ratio (OR) values were used to build the score. Results 340 patients were included, 240 in the derivation and 100 in the validation cohort. Multivariate analysis showed that major hepatectomy (OR = 1.62; 95% CI 1.39–3.51), liver stiffness ≥9.7 kPa (OR = 2.46; 95% CI 1.16–5.28), BILCHE score (combination of serum bilirubin and cholinesterase) ≥2 (OR = 2.76; 95% CI 0.82–4.28) and esophageal varices (OR = 1.59; 95% CI 1.51–3.61) were independent complications predictors. A 10-point scoring system was introduced. Patients with a score ≤4 did not experience complications, whereas patients with ≥7 points experienced up to 54% of complications (P < 0.001). Conclusions A new, easy and clinically reliable surgical score based on the liver stiffness, BILCHE score, type of hepatectomy, and presence of varices may be used to predict post-hepatectomy morbidity. Clinical trial number NCT02454686 (https://www.clinicaltrials.gov/).

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