title: Completion of a Liver Surgery Complexity Score and Classification Based on an International Survey of Experts.
abstract: Liver resections have classically been distinguished as "minor" or "major," based on number of segments removed. This is flawed because the number of segments resected alone does not convey the complexity of a resection. We recently developed a 3-tiered classification for the complexity of liver resections based on utility weighting by experts. This study aims to complete the earlier classification and to illustrate its application.
  
  
  
  Two surveys were administered to expert liver surgeons. Experts were asked to rate the difficulty of various open liver resections on a scale of 1 to 10. Statistical methods were then used to develop a complexity score for each procedure.
  
  
  
  Sixty-six of 135 (48.9%) surgeons responded to the earlier survey, and 66 of 122 (54.1%) responded to the current survey. In all, 19 procedures were rated. The lowest mean score of 1.36 (indicating least difficult) was given to peripheral wedge resection. Right hepatectomy with IVC reconstruction was deemed most difficult, with a score of 9.35. Complexity scores were similar for 9 procedures present in both surveys. Caudate resection, hepaticojejunostomy, and vascular reconstruction all increased the complexity of standard resections significantly.
  
  
  
  These data permit quantitative assessment of the difficulty of a variety of liver resections. The complexity scores generated allow for separation of liver resections into 3 categories of complexity (low complexity, medium complexity, and high complexity) on a quantitative basis. This provides a more accurate representation of the complexity of procedures in comparative studies.
authors.affiliation: Section of Hepato-Pancreato-Biliary Surgery, Washington University in Saint Louis, Saint Louis, MO; Barnes-Jewish Hospital, Saint Louis, MO; Siteman Cancer Center, Saint Louis, MO; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Major K
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO.
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.affiliation: Section of Hepato-Pancreato-Biliary Surgery, Washington University in Saint Louis, Saint Louis, MO; Barnes-Jewish Hospital, Saint Louis, MO; Siteman Cancer Center, Saint Louis, MO. Electronic address: strasbergs@wustl.edu.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
mesh_terms: D001291:Attitude of Health Personnel; D005060:Europe; D006498:Hepatectomy / Q000145:classification* / Q000379:methods; D006801:Humans; D009656:North America; D010818:Practice Patterns, Physicians'; D066231:Surgeons; D011795:Surveys and Questionnaires