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

• Published in: HPB (Oxford, England) Vol. 19; no. 10; pp. 910 - 918
• Main Authors: Donadon, Matteo, Fontana, Andrea, Palmisano, Angela, Viganò, Luca, Procopio, Fabio, Cimino, Matteo, Del Fabbro, Daniele, Torzilli, Guido
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2017
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2017.06.009

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. 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. 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). 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. NCT02454686 (https://www.clinicaltrials.gov/).