Model to predict postoperative complications after hepatectomy based on comprehensive complication index: A retrospective multicenter study

Abstract

Background

Postoperative complications following hepatectomy are often complex and involve multiple systems. This study aims to employ the Comprehensive Complication Index (CCI) to thoroughly assess postoperative complications, identify patients at high risk for severe complications, and inform preoperative management and preventive strategies.

Methods

In this retrospective study, we evaluated all adverse events within 30 days post-hepatectomy. Each complication was individually assessed, and CCI scores were calculated based on the Clavien-Dindo Classification (CDC) system. Short-term outcomes were analyzed for all patients to identify predictors of severe complications.

Results

A total of 1350 cases were analyzed, with 21 types of complications recorded, resulting in an overall complication rate of 46.61 %. Patients in the high CCI score group experienced significantly longer postoperative and total hospital stays. Independent risk factors identified included prolonged postoperative hospital stay, increased total intraoperative output, elevated postoperative blood creatinine levels, and preoperative pulmonary comorbidities. Conversely, a higher postoperative neutrophil ratio and red blood cell count were protective factors. Two surgical teams were associated with worse postoperative CCI outcomes. The nomogram model developed in this study demonstrated strong predictive performance, with an area under the ROC curve of 0.844 (95 % CI: 0.814–0.874), a sensitivity of 86.9 %, and a specificity of 65.4 %. The model estimated a 9.36 % risk of severe complications in patients with a total score of 36.

Conclusions

The predictive model developed in this study effectively identifies high-risk patients for severe complications after hepatectomy. This tool can guide perioperative preventive measures and early interventions to improve patient outcomes.