• Shogo Tanaka, Hiroya Iida, Masaki Ueno, Fumitoshi Hirokawa, Takeo Nomi, Takuya Nakai, Masaki Kaibori, Hisashi Ikoma, Hidetoshi Eguchi, Hiroji Shinkawa, Hiromitsu Maehira, Shinya Hayami, and Shoji Kubo.
• Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
• Ann. Surg. 2021 Sep 1; 274 (3): e253-e261.

ObjectiveTo establish a preoperative risk assessment method for loss of independence after hepatic resection.Summary Background DataHepatic resection often results in loss of independence in preoperatively self-sufficient elderly people. Elderly patients should therefore be carefully selected for surgery.MethodsIn this prospective, multicenter study, 347 independently-living patients aged ≥65 years, scheduled for hepatic resection, were divided into study (n = 232) and validation (n = 115) cohorts. We investigated the risk factors for postoperative loss of independence in the study cohort and verified our findings with the validation cohort. Loss of independence was defined as transfer to a rehabilitation facility, discharge to residence with home-based healthcare, 30-day readmission for poor functionality, and 90-day mortality (except for cancer-related deaths).ResultsIn the study cohort, univariate and multivariate analyses indicated that frailty, age ≥ 76 years, and open surgery were independent risk factors for postoperative loss of independence. Proportions of patients with postoperative loss of independence in the study and validation cohorts were respectively 3.0% and 0% among those with no applicable risk factors, 8.1% and 12.5% among those with 1 applicable risk factor, 25.5% and 25.0% among those with 2 applicable risk factors, and 56.3% and 50.0% among those with all 3 factors applicable (P < 0.001 for both cohorts). Areas under the receiver operating characteristic curves for the study and validation groups were 0.777 and 0.783, respectively.ConclusionsPreoperative risk assessments using these 3 factors may be effective in predicting and planning for postoperative loss of independence after hepatic resection in elderly patients.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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