Preoperative risk score for 90-day mortality after major liver resection

Sebastiaan Ceuppens; Pim B. Olthof; Arthur K.E. Elfrink; Stijn Franssen; Rutger Jan Swijnenburg; Joost M. Klaase; Maarten W. Nijkamp; Frederik J.H. Hoogwater; Andries E. Braat; Jeroen Hagendoorn; Wouter J.M. Derksen; Peter B. van den Boezem; Paul D. Gobardhan; Marcel den Dulk; Maxime J.L. Dewulf; Mike S.L. Liem; Wouter K.G. Leclercq; Eric J.T. Belt; Koert F.D. Kuhlmann; Niels F.M. Kok; Hendrik A. Marsman; Dirk Jan Grünhagen; Joris I. Erdmann; Bas Groot Koerkamp

doi:10.1016/j.gassur.2025.102064

Preoperative risk score for 90-day mortality after major liver resection

Sebastiaan Ceuppens^*, Pim B. Olthof, Arthur K.E. Elfrink, Stijn Franssen, Rutger Jan Swijnenburg, Joost M. Klaase, Maarten W. Nijkamp, Frederik J.H. Hoogwater, Andries E. Braat, Jeroen Hagendoorn, Wouter J.M. Derksen, Peter B. van den Boezem, Paul D. Gobardhan, Marcel den Dulk, Maxime J.L. Dewulf, Mike S.L. Liem, Wouter K.G. Leclercq, Eric J.T. Belt, Koert F.D. Kuhlmann, Niels F.M. KokHendrik A. Marsman, Dirk Jan Grünhagen, Joris I. Erdmann, Bas Groot Koerkamp^*

^*Corresponding author for this work

Surgery

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Abstract

Background:

Major liver resection is frequently performed for primary and secondary liver tumors. However, 90-day mortality rates can exceed 10% in high-risk patients. This study aimed to develop a preoperative risk score for postoperative mortality after major liver resection.

Methods:

All major liver resections between 2014 and 2019 in 2 Dutch tertiary referral centers were identified. A validation cohort consisted of all consecutive patients who underwent a major liver resection in the nationwide Dutch Hepato Biliary Audit from 2014 to 2020. Multivariate logistic regression was used to identify prognostic factors and develop a mortality risk score.

Results:

Major liver resection was performed in 513 patients, of whom 238 (46.4%) had a primary liver cancer, and in 148 patients (28.8%), a hepaticojejunostomy was performed; 90-day mortality occurred in 56 patients (10.8%). Mortality was independently predicted by 5 risk factors: age ≥ 65 years, diabetes mellitus type 2, diagnosis of primary liver cancer, American Society of Anesthesiologists ≥ 3, and extended hemihepatectomy. A risk score with 1 point assigned to each risk factor showed good discrimination (area under the curve [AUC], 0.77; 95% CI, 0.71–0.83). The predicted 90-day mortality was 3.5% for low-risk (0 or 1 points; 53.8% of all patients), 11.1% for intermediate-risk (2 points; 25.3%), and 29.7% for high-risk patients (3–5 points; 20.9%). External validation in the nationwide cohort with 1617 patients showed similar concordance (AUC, 0.69; 95% CI, 0.64–0.75).

Conclusion:

The proposed and validated risk score can aid in shared decision making.

Original language	English
Article number	102064
Journal	Journal of Gastrointestinal Surgery
Volume	29
Issue number	6
DOIs	https://doi.org/10.1016/j.gassur.2025.102064
Publication status	Published - Jun 2025

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Publisher Copyright:
© 2025 The Authors

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Ceuppens, S., Olthof, P. B., Elfrink, A. K. E., Franssen, S., Swijnenburg, R. J., Klaase, J. M., Nijkamp, M. W., Hoogwater, F. J. H., Braat, A. E., Hagendoorn, J., Derksen, W. J. M., van den Boezem, P. B., Gobardhan, P. D., den Dulk, M., Dewulf, M. J. L., Liem, M. S. L., Leclercq, W. K. G., Belt, E. J. T., Kuhlmann, K. F. D., ... Groot Koerkamp, B. (2025). Preoperative risk score for 90-day mortality after major liver resection. Journal of Gastrointestinal Surgery, 29(6), Article 102064. https://doi.org/10.1016/j.gassur.2025.102064

@article{3b13d5e104fe415cbdd57bc97c6028a3,

title = "Preoperative risk score for 90-day mortality after major liver resection",

abstract = "Background: Major liver resection is frequently performed for primary and secondary liver tumors. However, 90-day mortality rates can exceed 10% in high-risk patients. This study aimed to develop a preoperative risk score for postoperative mortality after major liver resection. Methods: All major liver resections between 2014 and 2019 in 2 Dutch tertiary referral centers were identified. A validation cohort consisted of all consecutive patients who underwent a major liver resection in the nationwide Dutch Hepato Biliary Audit from 2014 to 2020. Multivariate logistic regression was used to identify prognostic factors and develop a mortality risk score. Results: Major liver resection was performed in 513 patients, of whom 238 (46.4%) had a primary liver cancer, and in 148 patients (28.8%), a hepaticojejunostomy was performed; 90-day mortality occurred in 56 patients (10.8%). Mortality was independently predicted by 5 risk factors: age ≥ 65 years, diabetes mellitus type 2, diagnosis of primary liver cancer, American Society of Anesthesiologists ≥ 3, and extended hemihepatectomy. A risk score with 1 point assigned to each risk factor showed good discrimination (area under the curve [AUC], 0.77; 95% CI, 0.71–0.83). The predicted 90-day mortality was 3.5% for low-risk (0 or 1 points; 53.8% of all patients), 11.1% for intermediate-risk (2 points; 25.3%), and 29.7% for high-risk patients (3–5 points; 20.9%). External validation in the nationwide cohort with 1617 patients showed similar concordance (AUC, 0.69; 95% CI, 0.64–0.75). Conclusion: The proposed and validated risk score can aid in shared decision making.",

author = "Sebastiaan Ceuppens and Olthof, {Pim B.} and Elfrink, {Arthur K.E.} and Stijn Franssen and Swijnenburg, {Rutger Jan} and Klaase, {Joost M.} and Nijkamp, {Maarten W.} and Hoogwater, {Frederik J.H.} and Braat, {Andries E.} and Jeroen Hagendoorn and Derksen, {Wouter J.M.} and {van den Boezem}, {Peter B.} and Gobardhan, {Paul D.} and {den Dulk}, Marcel and Dewulf, {Maxime J.L.} and Liem, {Mike S.L.} and Leclercq, {Wouter K.G.} and Belt, {Eric J.T.} and Kuhlmann, {Koert F.D.} and Kok, {Niels F.M.} and Marsman, {Hendrik A.} and Gr{\"u}nhagen, {Dirk Jan} and Erdmann, {Joris I.} and {Groot Koerkamp}, Bas",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = jun,

doi = "10.1016/j.gassur.2025.102064",

language = "English",

volume = "29",

journal = "Journal of Gastrointestinal Surgery",

issn = "1091-255X",

publisher = "Society for Surgery of the Alimentary Tract",

number = "6",

}

Ceuppens, S, Olthof, PB, Elfrink, AKE, Franssen, S, Swijnenburg, RJ, Klaase, JM, Nijkamp, MW, Hoogwater, FJH, Braat, AE, Hagendoorn, J, Derksen, WJM, van den Boezem, PB, Gobardhan, PD, den Dulk, M, Dewulf, MJL, Liem, MSL, Leclercq, WKG, Belt, EJT, Kuhlmann, KFD, Kok, NFM, Marsman, HA, Grünhagen, DJ, Erdmann, JI & Groot Koerkamp, B 2025, 'Preoperative risk score for 90-day mortality after major liver resection', Journal of Gastrointestinal Surgery, vol. 29, no. 6, 102064. https://doi.org/10.1016/j.gassur.2025.102064

TY - JOUR

T1 - Preoperative risk score for 90-day mortality after major liver resection

AU - Ceuppens, Sebastiaan

AU - Olthof, Pim B.

AU - Elfrink, Arthur K.E.

AU - Franssen, Stijn

AU - Swijnenburg, Rutger Jan

AU - Klaase, Joost M.

AU - Nijkamp, Maarten W.

AU - Hoogwater, Frederik J.H.

AU - Braat, Andries E.

AU - Hagendoorn, Jeroen

AU - Derksen, Wouter J.M.

AU - van den Boezem, Peter B.

AU - Gobardhan, Paul D.

AU - den Dulk, Marcel

AU - Dewulf, Maxime J.L.

AU - Liem, Mike S.L.

AU - Leclercq, Wouter K.G.

AU - Belt, Eric J.T.

AU - Kuhlmann, Koert F.D.

AU - Kok, Niels F.M.

AU - Marsman, Hendrik A.

AU - Grünhagen, Dirk Jan

AU - Erdmann, Joris I.

AU - Groot Koerkamp, Bas

PY - 2025/6

Y1 - 2025/6

N2 - Background: Major liver resection is frequently performed for primary and secondary liver tumors. However, 90-day mortality rates can exceed 10% in high-risk patients. This study aimed to develop a preoperative risk score for postoperative mortality after major liver resection. Methods: All major liver resections between 2014 and 2019 in 2 Dutch tertiary referral centers were identified. A validation cohort consisted of all consecutive patients who underwent a major liver resection in the nationwide Dutch Hepato Biliary Audit from 2014 to 2020. Multivariate logistic regression was used to identify prognostic factors and develop a mortality risk score. Results: Major liver resection was performed in 513 patients, of whom 238 (46.4%) had a primary liver cancer, and in 148 patients (28.8%), a hepaticojejunostomy was performed; 90-day mortality occurred in 56 patients (10.8%). Mortality was independently predicted by 5 risk factors: age ≥ 65 years, diabetes mellitus type 2, diagnosis of primary liver cancer, American Society of Anesthesiologists ≥ 3, and extended hemihepatectomy. A risk score with 1 point assigned to each risk factor showed good discrimination (area under the curve [AUC], 0.77; 95% CI, 0.71–0.83). The predicted 90-day mortality was 3.5% for low-risk (0 or 1 points; 53.8% of all patients), 11.1% for intermediate-risk (2 points; 25.3%), and 29.7% for high-risk patients (3–5 points; 20.9%). External validation in the nationwide cohort with 1617 patients showed similar concordance (AUC, 0.69; 95% CI, 0.64–0.75). Conclusion: The proposed and validated risk score can aid in shared decision making.

AB - Background: Major liver resection is frequently performed for primary and secondary liver tumors. However, 90-day mortality rates can exceed 10% in high-risk patients. This study aimed to develop a preoperative risk score for postoperative mortality after major liver resection. Methods: All major liver resections between 2014 and 2019 in 2 Dutch tertiary referral centers were identified. A validation cohort consisted of all consecutive patients who underwent a major liver resection in the nationwide Dutch Hepato Biliary Audit from 2014 to 2020. Multivariate logistic regression was used to identify prognostic factors and develop a mortality risk score. Results: Major liver resection was performed in 513 patients, of whom 238 (46.4%) had a primary liver cancer, and in 148 patients (28.8%), a hepaticojejunostomy was performed; 90-day mortality occurred in 56 patients (10.8%). Mortality was independently predicted by 5 risk factors: age ≥ 65 years, diabetes mellitus type 2, diagnosis of primary liver cancer, American Society of Anesthesiologists ≥ 3, and extended hemihepatectomy. A risk score with 1 point assigned to each risk factor showed good discrimination (area under the curve [AUC], 0.77; 95% CI, 0.71–0.83). The predicted 90-day mortality was 3.5% for low-risk (0 or 1 points; 53.8% of all patients), 11.1% for intermediate-risk (2 points; 25.3%), and 29.7% for high-risk patients (3–5 points; 20.9%). External validation in the nationwide cohort with 1617 patients showed similar concordance (AUC, 0.69; 95% CI, 0.64–0.75). Conclusion: The proposed and validated risk score can aid in shared decision making.

UR - http://www.scopus.com/inward/record.url?scp=105004220053&partnerID=8YFLogxK

U2 - 10.1016/j.gassur.2025.102064

DO - 10.1016/j.gassur.2025.102064

M3 - Article

C2 - 40253050

AN - SCOPUS:105004220053

SN - 1091-255X

VL - 29

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

IS - 6

M1 - 102064

ER -

Preoperative risk score for 90-day mortality after major liver resection

Abstract

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