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Score of Yamanaka et al for Severity of Postoperative Hepatic Dysfunction Following Partial Hepatectomy

Purpose: To determine the severity of postoperative hepatic dysfunction following hepatectomy using the score of Yamanaka et al.

Description

Yamanaka et al used a scoring system to grade the severity of postoperative hepatic dysfunction following hepatectomy. The authors are from Hyogo College of Medicine in Japan.


Patient selection: partial hepatectomy for hepatocellular carcinoma

 

Risk factors for postoperative hepatic failure:

(1) too much removed

(2) too little reserve

 

Parameters:

(1) stage of hepatic encephalopathy

(2) ascites

(3) hyperammonemia based on blood ammonia

(4) hyperbilirubinemia based on serum total bilirubin

 

Parameter

Finding

Points

grade of encephalopathy

none

0

 

stage I or II

20

 

stage III or IV

40

ascites

absent

0

 

present

10

serum ammonia

< 130 µg/dL (normal)

0

 

130 to 180 µg/dL

10

 

> 180 µg/dL (>=1.4 times ULN)

20

serum total bilirubin

< 1.2 mg/dL (normal)

0

 

1.2 to 6.0 mg/dL

0

 

> 6 mg/dL

10 * ((value) – 6)

 

where:

• Point assignment appears simplistic, using simple multiples.

 

total score =

= SUM(points for all 4 parameters)

 

Postoperative mortality was also scored:

 

Parameter

Finding

Points

postoperative mortality

none

0

 

<= 30 days after surgery (1 month)

100

 

> 30 days after surgery

80

 

Interpretation:

• minimum total score: 0

• maximum total score for survivor: uncertain, may be capped at 60

• maximum total score: 100


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Specialty

Objective

ICD-10