title: The predictive value of postoperative clinical risk scores for outcome after hepatic resection: a validation analysis in 807 patients.
abstract: BACKGROUND
  Although early postoperative risk stratification might allow a more precise prediction of outcomes after hepatic resection, evaluation of different postoperative clinical risk indices has been lacking.
  
  
  METHODS
  A total of 1,219 patients underwent hepatic resection between January 2002 and 2010, and 807 patients were eligible for final analyses. The model for end stage liver disease (MELD) score, the "50-50 criteria," and the International Study Group of Liver Surgery (ISGLS) definition of posthepatectomy liver failure (PHLF) were assessed as clinical risk scores on postoperative day 5. Risk factors for morbidity and mortality were analyzed using multivariate logistic regression analyses.
  
  
  RESULTS
  The overall morbidity and mortality rates were 43 and 6%, respectively. Sensitivity of the MELD score, the 50-50 criteria and the PHLF for prediction of morbidity and mortality were 55, 6, 23 and 71, 26, 65%. On multivariate analyses MELD score [odds ratio (OR) 2.06; 95% confidence interval (95% CI) 1.41-3.02] and PHLF (5.61; 2.73-11.55) were associated with morbidity, whereas this association did not reach statistical significance for the 50-50 criteria (3.64; 0.78-17.02). The 50-50 criteria (16.45; 3.50-77.25) and PHLF (13.80; 4.27-44.61) were identified as powerful, independent predictors of mortality. This association was less strong for the MELD score (2.86; 0.98-8.31).
  
  
  CONCLUSIONS
  Postoperative clinical risk scores are associated independently with outcome after hepatic resection. Owing to lack of sensitivity only the MELD score can be recommended for early prediction of overall morbidity, whereas the MELD score and the PHLF enabled adequate risk stratification regarding perioperative mortality.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Christoph
authors.initials: C
authors.lastname: Reissfelder
authors.forename: Moritz
authors.initials: M
authors.lastname: Koch
authors.forename: Heike
authors.initials: H
authors.lastname: Elbers
authors.forename: Fabian
authors.initials: F
authors.lastname: Striebel
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D058625:End Stage Liver Disease / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055815:Young Adult