Area deprivation index and outcomes after major hepatectomy: A potential role in identifying patients at risk for mortality.

Abstract

Increased area deprivation index is associated with worse outcomes following major surgery; yet prior analyses include heterogenous populations and have not studied morbidity and mortality after hepatectomy. We examine whether an increased area deprivation index is associated with serious morbidity and 90-day mortality after major hepatectomy. A retrospective review of patients undergoing major hepatectomy between 2014 and 2023 at a single-health system was performed. The area deprivation index was stratified into tiers, with increasing area deprivation index reflective of worsening neighborhood disadvantage: lower = 0-49, middle = 50-69, and upper = 70-100. Firth multivariable regression analyses were performed to identify adjusted associations of area deprivation index with postoperative serious morbidity and 90-day mortality. Of the 166 patients included, most (n = 101, 61%) underwent right hepatectomy for metastatic cancer (n = 71, 43%). Stratified by area deprivation index, 77 (47%) patients were in the lower tier, 35 (21%) in the middle tier, and 54 (32%) in the upper tier. Morbidity occurred in 89 patients (54%), and 90-day mortality occurred in 8 patients (4.9%), most commonly (6/8, 75%) because of posthepatectomy liver failure. Hepaticojejunostomy (odds ratio, 12.5; 95% confidence interval, 1.34-1,669; P = .023) and cholangiocarcinoma (odds ratio, 3.84; 95% confidence interval, 1.34-12.2; P = .011) were both independently associated with morbidity, whereas upper-tier area deprivation index (odds ratio, 5.47; 95% confidence interval, 1.05-42.2; P = .043) was the only factor independently associated with 90-day mortality. Worsening neighborhood disadvantage, measured by an increasing area deprivation index, is associated with 90-day mortality, but not morbidity, after major hepatectomy, with most deaths resulting from posthepatectomy liver failure. A high area deprivation index may indicate a need for additional preoperative preparation.