Institutional Utilization of Postoperative Mortality Predicted by a Nationwide Survey-Based Risk Calculator in Patients Who Underwent Major Hepatectomy

Abstract

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 cutoff value for high-risk mortality was set at 5%. Patients were divided into 4 groups: (1) no severe complications and low predictive mortality rate (woML), (2) severe complications or mortality, and low mortality rate (wML), (3) no severe complications and high mortality rate (woMH), and (4) severe complications or mortality, and high mortality rate (wMH). Results Morbidity higher than Clavien Dindo III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and 2 (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (P < 0.01). Age, elderly patients, diseases, and comorbidity 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 2 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.