Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
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:
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.
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
Research background

Predicting, evaluating, and intervening in surgical risk and preventing pulmonary complications of liver surgery have become major clinical problems.

Research motivation

Postoperative pulmonary complications (PPCs) are important adverse events associated with surgery and anesthesia. At present, there is no perfect system to evaluate the risk of pulmonary complications following liver surgery using perioperative variables.

Research objectives

This study aimed to design and verify a risk assessment system for predicting PPCs after hepatectomy based on perioperative variables.

Research methods

A retrospective analysis was performed on 1633 patients undergoing liver surgery. All factors that were significantly correlated with postoperative adverse outcomes were included in the multivariate logistic regression analysis. A scoring system [the liver operation pulmonary complication scoring system (LOPCSS)] was introduced based on the odds ratio (OR) values for these factors. The sum of the risk scores of all risk factors for a single patient was the total risk score of the patient’s complications. The cut-off value was used to determine the critical point of complications.

Research results

The independent factors influencing PPCs of liver surgery were age (≥ 65 years old/< 65 years old, 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 cut-off value of the expected score for complications was 5.

Research conclusions

As a novel and simplified assessment system, the LOPCSS can effectively predict PPCs of liver surgery using perioperative variables.

Research perspectives

We screened for perioperative risk factors associated with pulmonary complications in liver surgery and established a scoring system to predict the occurrence of complications.