Background For colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality. Methods All patients were treated according to the same fast-track programme. Complications were graded according to the Clavien–Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression. Results 564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17–1.64%). Complications were common with Grade ≤ 2 in 167 patients (30%) and ≥ Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3–1.5) for Grade 2, 1.7 days (1.5–2.0) for Grade 3a, 2.3 days (1.7–3.0) for Grade 3b, 2.6 days (1.6–4.2) for Grade 4a, and 2.9 days (2.8–3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, biliary, cardiopulmonary, and infectious complications. Conclusions Complications after liver surgery for colorectal liver metastases, in a fast track setting, were associated with low mortality, and even severe complications only prolonged length of stay to a minor degree.

PURPOSE:Increased model for end-stage liver disease (MELD) score measured in the early postoperative course is associated with one-year mortality and graft loss. However, the correlation with postoperative complications has not been investigated. The aim of this study was to investigate the association between postoperative MELD score and subsequent complications.METHODS:Adult liver transplant recipients transplanted from January 2011 until December 2016 were included. MELD score days 1-5 were correlated with complications day 6-30, subdivided into type and severity according to Clavien-Dindo classification.RESULTS:We included 246 adult liver transplant recipients. Between days 6 and 30, 671 complications occurred in 201 of the patients (82%) corresponding to 64% of all postoperative complications in the whole postoperative period (days 0-30). In multivariate analyses adjusted for recipient gender and age, preoperative MELD score, and Eurotransplant Donor Risk Index, postoperative MELD score was significantly associated with having one or more complications, any type of complication except cardiovascular and renal complications, and complication severity.CONCLUSIONS:Postoperative MELD score days 1-5 were associated with complications arising in the subsequent period 6-30 days after transplantation. An increased MELD score should heighten the clinician's awareness of a possible complication.

Egeland, Charlotte K. MD; Rostved, Andreas A. MD, PhD; Aagaard Schultz, Nikolai MD, PhD; Pommergaard, Hans-Christian MD, PhD; Daugaard, Thomas R. MD; Thoefner, Line B. MD; Hillingsoe, Jens MD, PhD; Rasmussen, Allan MD Author Information

Background: Liver transplantation is major surgery with a high risk of complications. Existing scoring systems for evaluating complications after surgery are not specific for liver transplantation. Nor are they designed to evaluate the relation to recipient survival or graft loss. We wished to uncover the relation between postoperative complications and one-year risk of death or retransplantation, and to develop a prognostic score for complications based on our findings. Method: The study was a retrospective cohort study including 253 adult liver recipients. Thirty-days postoperative complications were registered using the Clavien-Dindo classification. A prognostic score was developed based on types, severity, and quantity of complications. Results: A total of 1113 complications occurred in 233 (92.1 %) of the patients. One-year mortality or graft loss was associated with graft, biliary, surgical, systemic, pulmonary, cardiovascular, renal, and infectious complication but not with neurologic or gastrointestinal complications. The developed score was more accurate in predicting the outcome than both the modified Clavien-Dindo score and the Comprehensive Complication Index. Conclusion: Types, severity, and quantity of different postoperative complications after liver transplantation are not equally important. The proposed score may focus attention on treating or preventing complications with strong relation to recipient mortality or graft loss.