A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

• Published in: World journal of surgery 2021-06, Vol.45 (6), p.1868-1876
• Main Authors: Tomita, Koichi, Koganezawa, Itsuki, Nakagawa, Masashi, Ochiai, Shigeto, Gunji, Takahiro, Yokozuka, Kei, Ozawa, Yosuke, Hikita, Kosuke, Kobayashi, Toshimichi, Sano, Toru, Chiba, Naokazu, Kawachi, Shigeyuki
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cardiac Surgery; Complications; General Surgery; Hepatectomy; Medicine; Medicine & Public Health; Multivariate analysis; Muscles; Musculoskeletal system; Older people; Original Scientific Report; Postoperative period; Regression analysis; Risk analysis; Risk factors; Serum albumin; Skeletal muscle; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-021-05985-w

Background Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). Methods Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. Results Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 ( p  = 0.001), which was better than that of other known surgical risk indexes. Conclusion Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.