A Novel Difficulty Classification for Perioperative Risk Assessment in High-level Hepatobiliary Pancreatic Surgeries

[Purpose :] Although mortality and morbidity rate of high-level hepatobiliary pancreatic (HBP) surgery has been improved, which remains still high in some procedures. The difficulty of high-level HBP surgeries are varies depending on the surgical complexity, thereby perioperative outcomes can be variable. The aim this study was to establish a novel difficulty classification of high-level HBP surgeries and to assess its validity. [Methods :] High-level HBP surgeries were classified into four groups, A to D, in order of increasing difficulty, based on the expert opinion. A total of 473 patients who underwent high-level HBP surgery from July 2014 to July 2021 in our hospital were classified into aforementioned four groups, and surgical and postoperative outcomes of which were compared. [Results :] The numbers of patients in each difficulty group were as follows : A (n=62), B (n=278), C (n=74) and D (n=59). Operation time and blood loss showed a significant stepwise increase in the group A to D (p