Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database risk calculator (NCD-RC) was examined . Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies . The cut-off value for high-risk mortality was set at 5%. Patients were divided into four groups: A) no severe complications and low predictive mortality rate (woML) , B) severe complications or mortality, and low mortality rate (wML) , C) no severe complications and high mortality rate (woMH) , and D) severe complications or mortality, and high mortality rate (wMH) . Results: Morbidity higher than CD III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and two (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (p<0.01). Age, elderly patients, diseases, and co-morbidity did not significantly differ among groups. Although bile leakage was common in group wML , there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and two died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.
Institutional actual utilization of postoperative mortality using nationwide survey based risk calculator in patients who underwent major hepatectomy
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Atsushi Nanashima, Naoya Imamura, Masahide Hiyoshi, Koichi Yano, Takeomi Hamada, Takahiro Nishida, Daichi Sakurahara, Risa Sakamoto, Yukako Uchise, Takashi Wada, Kenzo Nagatomo; Institutional actual utilization of postoperative mortality using nationwide survey based risk calculator in patients who underwent major hepatectomy. Int Surg 2021; doi: https://doi.org/10.9738/INTSURG-D-20-00041.1
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