title: Reductions in post-hepatectomy liver failure and related mortality after implementation of the LiMAx algorithm in preoperative work-up: a single-centre analysis of 1170 hepatectomies of one or more segments.
abstract: OBJECTIVE
  Post-hepatectomy liver failure has a major impact on patient outcome. This study aims to explore the impact of the integration of a novel patient-centred evaluation, the LiMAx algorithm, on perioperative patient outcome after hepatectomy.
  
  
  METHODS
  Trends in perioperative variables and morbidity and mortality rates in 1170 consecutive patients undergoing elective hepatectomy between January 2006 and December 2011 were analysed retrospectively. Propensity score matching was used to compare the effects on morbidity and mortality of the integration of the LiMAx algorithm into clinical practice.
  
  
  RESULTS
  Over the study period, the proportion of complex hepatectomies increased from 29.1% in 2006 to 37.7% in 2011 (P = 0.034). Similarly, the proportion of patients with liver cirrhosis selected for hepatic surgery rose from 6.9% in 2006 to 11.3% in 2011 (P = 0.039). Despite these increases, rates of post-hepatectomy liver failure fell from 24.7% in 2006 to 9.0% in 2011 (P < 0.001) and liver failure-related postoperative mortality decreased from 4.0% in 2006 to 0.9% in 2011 (P = 0.014). Propensity score matching was associated with reduced rates of post-hepatectomy liver failure [24.7% (n = 77) versus 11.2% (n = 35); P < 0.001] and related mortality [3.8% (n = 12) versus 1.0% (n = 3); P = 0.035].
  
  
  CONCLUSIONS
  Postoperative liver failure and postoperative liver failure-related mortality decreased in patients undergoing hepatectomy following the implementation of the LiMAx algorithm.
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Jara
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Reese
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Erika
authors.initials: E
authors.lastname: Valle
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department for General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
mesh_terms: D000368:Aged; D000465:Algorithms; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D005260:Female; D005858:Germany; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome