Smart phone application to increase safety in liver surgery

Surgical removal of parts of the liver remains the only curative approach for patients with liver-specific cancer. An international team led by Patrick Starlinger from MedUni Vienna has developed a score that provides an individualized risk assessment for patients prior to liver resection, which could significantly increase the safety of liver surgery.

This score can be calculated using a simple smartphone app and, compared to standard preoperative testing, offers a cheaper and less invasive option with comparable or better predictive ability for postoperative liver failure. The effectiveness of the score was confirmed in an international multicenter study with more than 14,000 patients.

Normally, the liver can tolerate the surgical removal of up to 75% of its volume and can maintain its functions after surgery. However, depending on the underlying chronic liver disease, the type of cancer, or the extent of resection, patients may be at greater risk for inadequate postoperative liver regeneration or even postoperative liver failure, the leading cause of death after liver surgery.

Because there is no treatment for this, a risk assessment before surgery is essential. However, established preoperative liver function tests are often associated with significant cost, time, and invasiveness and are rarely compared directly.

APRI + ALBI score facilitates preoperative assessment of liver function

A team from 10 different international liver surgery centers led by Patrick Starlinger (Medical University of Vienna/University Hospital Vienna and Mayo Clinic, Rochester, USA) has developed a multivariable model based on the basic patient: in characteristics and a preoperative score, the APRI + ALBI score, which allows a standardized and easily accessible preoperative assessment of liver function.

The APRI + ALBI score is calculated using simple routine laboratory parameters (GOT, platelets, albumin, bilirubin). It has already been shown to be closely associated with preoperative liver function and chemotherapy-induced liver damage, and to have significant predictive potential for the development of postoperative liver failure. The APRI + ALBI score provides a comprehensive assessment of liver function, especially when compared to classical liver function tests, which typically only assess the excretory capacity of the liver.

The study included more than 14,000 patients from 10 different institutions and the National Surgery Quality Improvement Program (NSQIP), an algorithm-based database from the United States. The model showed significant predictive performance, which was validated in the international multicenter cohort.

“We are very pleased with the strong predictive potential of our model, which documents the significant clinical utility of our score and its associated smartphone app,” says Jonas Santol, first author of the manuscript, surgical resident at Klinikum Favoriten and PhD candidate. student at the MedUni Vienna Center for Physiology and Pharmacology, who is currently on a research residency at the Mayo Clinic.

The multivariable model based on the APRI + ALBI score is easy to calculate using routine laboratory values ​​and basic patient characteristics, and can be calculated using a freely available smartphone app. Compared to established liver function tests, it shows equivalent or improved prediction of liver failure at a fraction of the cost, time and invasiveness.

“We have taken an important step in translating this into clinical practice by developing a freely available smartphone application that allows us to calculate our score and thus individualize the risk assessment of patients before liver resection. This sets a new standard in preoperative risk assessment and will significantly increase the safety of liver surgery for our patients,” says Patrick Starlinger of MedUni Vienna’s Department of General Surgery at MedUni Vienna/University Hospital Vienna, currently based at the Mayo Clinic.