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Development of a preoperative score to predict surgical difficulty in liver transplantation.
- Source :
- Surgery; Nov2022, Vol. 172 Issue 5, p1529-1536, 8p
- Publication Year :
- 2022
-
Abstract
- A difficulty score to predict intraoperative surgical complexity in liver transplantation has never been developed. The aim of this study was to assess factors associated with a difficult liver transplant and develop a score to predict difficult surgery. All patients undergoing deceased donor whole liver transplantation from 2012 to 2019 at a single center were included. Estimated intraoperative blood loss (mL/kg) and surgery duration (skin-to-arterial reperfusion time) were used as surrogates of difficulty. Based on these variables, the study population was divided into 2 groups: high risk and standard risk of difficulty. Univariate and multivariate analyses were performed to identify predictors associated with a demanding liver transplantation and develop a difficulty score. A total of 515 patients were included in the study population, and 101 (20%) were considered difficult operations. Patients with a higher risk of difficulty showed a significantly higher rate of Clavien-Dindo ≥III complications (50.5% vs 24.4%, P =.001) and a longer hospital stay (19 vs 16 days, P =.001). Preoperative factors associated with difficulty were retransplantation (odds ratio 4.34, P =.001), preoperative portal vein thrombosis (odds ratio 3.419, P =.001), previous upper abdominal surgery (odds ratio 2.161, P =.003), spontaneous bacterial peritonitis (odds ratio 1.985, P <.02), and prior variceal bleeding (odds ratio 1.401, P =.051). A 10-point difficulty score was created, showing a negative predictive value of 84% at 4 points. Difficult liver transplantation surgery, as assessed by skin-to-arterial reperfusion time and estimated blood loss, is associated with worse perioperative outcomes. We developed a simple score with clinical preoperative variables that predicts difficult surgery, and therefore, it may help to optimize allocation policies and perioperative logistics. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00396060
- Volume :
- 172
- Issue :
- 5
- Database :
- Supplemental Index
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 159625689
- Full Text :
- https://doi.org/10.1016/j.surg.2022.07.001