Clinical evaluation of the Cystic Echinococcosis Complication Score for preoperative risk stratification and surgical planning in hepatic cystic echinococcosis: A retrospective derivation and comparative cohort study.

Abstract

Surgical management of hepatic cystic echinococcosis is frequently associated with substantial postoperative morbidity. The absence of a validated, disease-specific risk stratification tool hinders optimal patient referral, surgical planning, and perioperative resource allocation. This study evaluates the clinical utility of the Cystic Echinococcosis Complication Score for preoperative risk assessment and its association with postoperative outcomes. The Cystic Echinococcosis Complication Score was derived from a retrospective cohort of 746 patients who underwent echinococcectomy between January 2015 and December 2020. Multivariable logistic regression identified 12 independent predictors of postoperative complications, which were weighted to construct the Cystic Echinococcosis Complication Score. To evaluate its clinical impact, we conducted a retrospective comparative analysis of 2 sequential cohorts: a historical control group managed without formal risk stratification (n = 106, January 2018-December 2020) and a Cystic Echinococcosis Complication Score-guided group where preoperative assessment and surgical planning were systematically informed by the score (n = 110, January 2021-December 2023). Primary outcomes included the incidence and severity of postoperative complications (Clavien-Dindo classification) and preoperative tactical modifications. Implementation of Cystic Echinococcosis Complication Score-guided risk stratification was associated with a significant reduction in overall postoperative complications (12.7% vs 31.1%; χ² = 10.741; P = .001) and a decrease in clinically significant complications (Clavien-Dindo III-V: 0.9% vs 5.7%; P = .031). Preoperative management was modified in 29 patients (26.4%) in the Cystic Echinococcosis Complication Score cohort, including referral to higher-level centers (n = 11), involvement of senior surgeons (n = 14), and short-course preoperative optimization (n = 4). Median hospital stay was shorter in the Cystic Echinococcosis Complication Score group (6.2 vs 7.5 days; P = .0002). The Cystic Echinococcosis Complication Score is a feasible, clinically applicable tool for preoperative risk stratification in hepatic cystic echinococcosis. Its systematic use was associated with improved perioperative decision-making and a lower burden of postoperative complications. Given the historical control design, causal inference is limited, and observed improvements may also reflect evolving institutional expertise. Prospective, multicenter external validation is warranted to confirm the score's generalizability and predictive performance.