title: Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery.
abstract: OBJECTIVE
  This study evaluated the ability of general surgical models to predict postoperative morbidity and mortality in liver surgery.
  
  
  METHODS
  The postoperative course and mortality rates predicted by general surgical models were investigated in 960 patients who underwent hepatectomy or ablation therapy for primary or metastatic liver carcinoma.
  
  
  RESULTS
  The area under the receiver operative characteristic curve (95% confidence intervals) for detecting postoperative liver failure was 0.89 (0.84-0.94), 0.85 (0.78-0.92), and 0.78 (0.72-0.85) for the estimation of physiologic ability and surgical stress (E-PASS) model, the modified E-PASS (mE-PASS) model, and the Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) model, respectively, and those for detecting in-hospital mortality were 0.85 (0.76-0.93), 0.85 (0.78-0.92), and 0.79 (0.71-0.87), respectively. Nevertheless, all of the models overpredicted the overall mortality rate (by 2.3-fold for E-PASS, 2.3-fold for mE-PASS, and 2.9-fold for P-POSSUM).
  
  
  CONCLUSIONS
  The general surgical risk models demonstrated high discriminatory power for predicting postoperative outcomes in liver surgery, but overpredicted the overall mortality rate by more than twofold. Therefore, these models should be refined to make them more suitable for predicting liver surgery outcomes.
authors.affiliation: Institute for Clinical Research, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan. yoshio@kumamoto.hosp.go.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Haga
authors.forename: Koji
authors.initials: K
authors.lastname: Ikejiri
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ikenaga
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Wada
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002648:Child; D005260:Female; D006305:Health Status Indicators; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D017093:Liver Failure / Q000453:epidemiology* / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult