Xu LN, Xu YY, Li GP, Yang B. Individualized risk estimation for postoperative pulmonary complications after hepatectomy based on perioperative variables. World J Gastrointest Surg 2022; 14(7): 685-695 [PMID: 36158277 DOI: 10.4240/wjgs.v14.i7.685]
Corresponding Author of This Article
Bo Yang, Doctor, Chief Doctor, Department of Radiology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. yangbo010027@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2022; 14(7): 685-695 Published online Jul 27, 2022. doi: 10.4240/wjgs.v14.i7.685
Individualized risk estimation for postoperative pulmonary complications after hepatectomy based on perioperative variables
Li-Ning Xu, Ying-Ying Xu, Gui-Ping Li, Bo Yang
Li-Ning Xu, Department of General Surgery, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
Ying-Ying Xu, Department of Internal Medicine, Henan Cancer Hospital, Zhengzhou 450003, Henan Province, China
Gui-Ping Li, Department of Radiology, Hubei Province Integrated Hospital of Chinese and Western Medicine, Wuhan 430015, Hubei Province, China
Bo Yang, Department of Radiology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Author contributions: Xu LN, Xu YY and Li GP contributed equally to this work; Xu LN and Xu YY were the gastroenterologists; Li GP and Yang B performed the radiological diagnosis; Xu LN and Yang B analyzed the data and wrote the manuscript; Xu LN, Xu YY, Li GP and Yang B designed the research, performed the primary literature and data extraction, they were responsible for revising the manuscript for important intellectual content; and all authors read and approved the final version.
Institutional review board statement: The study was approved by the Medical Ethics Committee of the Chinese PLA General Hospital.
Informed consent statement: This is a retrospective study, so informed consent is not involved.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author at yangbo010027@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Yang, Doctor, Chief Doctor, Department of Radiology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. yangbo010027@163.com
Received: March 25, 2022 Peer-review started: March 25, 2022 First decision: May 29, 2022 Revised: June 5, 2022 Accepted: July 5, 2022 Article in press: July 5, 2022 Published online: July 27, 2022 Processing time: 124 Days and 4.7 Hours
Abstract
BACKGROUND
At present, there is no perfect system to evaluate pulmonary complications of liver surgery using perioperative variables.
AIM
To design and verify a risk assessment system for predicting postoperative pulmonary complications (PPCs) after hepatectomy based on perioperative variables.
METHODS
A retrospective analysis was performed on 1633 patients who underwent liver surgery. The variables were screened using univariate and multivariate analyses, and graded scores were assigned to the selected variables. Logistic regression was used to develop the liver operation pulmonary complication scoring system (LOPCSS) for the prediction of PPCs. The LOPCSS was verified using the receiver operating characteristic curve.
RESULTS
According to the multivariate correlation analysis, the independent factors which influenced PPCs of liver surgery were age [≥ 65 years old/< 65 years old, odds ratio (OR) = 1.926, P = 0.011], medical diseases requiring drug treatment (yes/no, OR = 3.523, P < 0.001), number of liver segments to be removed (≥ 3/≤ 2, OR = 1.683, P = 0.002), operation duration (≥ 180 min/< 180 min, OR = 1.896, P = 0.004), and blood transfusion (yes/no, OR = 1.836, P = 0.003). The area under the curve (AUC) of the LOPCSS was 0.742. The cut-off value of the expected score for complications was 5. The incidence of complications in the group with ≤ 4 points was significantly lower than that in the group with ≥ 6 points (2.95% vs 33.40%, P < 0.001). Furthermore, in the validation dataset, the corresponding AUC of LOPCSS was 0.767.
CONCLUSION
As a novel and simplified assessment system, the LOPCSS can effectively predict PPCs of liver surgery through perioperative variables.
Core Tip: In this study, a binomial logistic regression model was established to obtain the liver operation pulmonary complication scoring system (LOPCSS). The area under the curve of the LOPCSS was 0.742. As a novel and simplified assessment system, the LOPCSS can effectively predict postoperative pulmonary complications of liver surgery through perioperative factors; therefore, it can be used to evaluate the risk of liver surgical pulmonary complications.
