Early predictive factors for severe postoperative complications following major liver and pancreatic surgery: A single-center retrospective study

Background Postoperative severe complications (PSC) serve as critical metrics of surgical performance, significantly escalating healthcare expenditure, impeding timely initiation of adjuvant chemotherapy, and compromising long-term survival. Generally speaking, hepato-bilially-pancreatic surgeons are required to have the ability to perform and manage both liver and pancreatic surgery, which are different in nature. Therefore, it is important to have a comprehensive understanding of both liver and pancreatic surgery.This investigation aims to identify perioperative predictive factors for PSC after these surgeries. Methods This single-center retrospective study enrolled 675 patients who underwent major liver and pancreatic surgeries between January 2010 and December 2023 at Gifu University Hospital, Japan. Perioperative predictive factors were evaluated in 328 patients with both PSC (n = 167; liver n = 49, pancreas n = 118; Clavien–Dindo (CD) classification grades ≥ III) and non-PSC (n = 161; liver n = 53, pancreas n = 108; CD classification grades < III) using univariate and multivariate analyses. Results PSC after major pancreatic surgery was significantly associated with male sex (p = 0.01), higher BMI (p = 0.03), history of smoking (p = 0.02), history of malignancy (p = 0.02), respiratory-related comorbidity (p = 0.04), and CAR, NLR, and PLR on POD3 (p < 0.001, p < 0.01, and p < 0.01, respectively) in the univariate analysis. In the multivariate analysis, only CAR on POD3 (> 5.0, OR, 4.27; 95% CI, 2.05–9.13; p < 0.001) was an independent predictive factor for PSC after major pancreatic surgery. On the other hands, PSC after major liver surgery was significantly associated with an abnormal CONUT score (p = 0.04) and heart-related comorbidities (p = 0.04) in the univariate analysis. In the multivariate analysis, only an abnormal CONUT score (OR, 3.40; 95% CI, 1.37–8.81; p < 0.01) was an independent predictive factor for PSC following major liver surgery . Conclusions Postoperative inflammatory markers may be early predictive factors for complication severity after major pancreatectomy. On the other hand, an abnormal preoperative CONUT score was an independent predictor of major liver surgery. The study advocates for the implementation of proactive postoperative strategies guided by inflammatory biomarkers in major pancreatic surgery and posits that targeted nutritional optimization prior to major hepatectomy may facilitate expedited recovery and favorable outcomes.