Completion of a Liver Surgery Complexity Score and Classification Based on an International Survey of Experts

• Published in: Journal of the American College of Surgeons Vol. 223; no. 2; pp. 332 - 342
• Main Authors: Lee, Major K., MD, PhD, Gao, Feng, PhD, Strasberg, Steven M., MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Attitude of Health Personnel; Europe; Hepatectomy - classification; Hepatectomy - methods; Humans; North America; Practice Patterns, Physicians; Surgeons; Surgery; Surveys and Questionnaires
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2016.03.039

Abstract Background Liver resections have classically been distinguished as “minor” or “major” based on number of segments removed. This is flawed since the number of segments resected alone does not convey the complexity of a resection. We recently developed a three-tiered classification for the complexity of liver resections based on utility weighting by experts. This study aims to complete the prior classification and to illustrate its application. Study Design Two surveys were administered to expert liver surgeons. Experts were asked to rate the difficulty of various open liver resections on a scale of 1-10. Statistical methods were then used to develop a complexity score for each procedure. Results 66 of 135 (48.9%) surgeons responded to the prior survey, and 66 of 122 (54.1%) responded to the current survey. In all, 19 procedures were rated. The lowest mean score of 1.36—indicating least difficulty—was given to peripheral wedge resection. Right hepatectomy with IVC reconstruction was deemed most difficult with a score of 9.35. Complexity scores were similar for nine procedures present in both surveys. Caudate resection, hepaticojejunostomy, and vascular reconstruction all significantly increased the complexity of standard resections. Conclusions These data permit quantitative assessment of the difficulty of a variety of liver resections. The complexity scores generated allow for separation of liver resections into three categories of complexity (Low Complexity, Medium Complexity, and High Complexity) on a quantitative basis. This allows more accurate representation of the complexity of procedures in comparative studies.