APACHE III, unlike APACHE II, predicts posthepatectomy mortality in patients with biliary tract carcinoma

Objective: To evaluate Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III scores after liver resection and to elucidate whether APACHE III is more accurate as a predictor of posthepatectomy mortality. Design: Retrospective, cohort study. Setting: Intensive care unit in a tertiary care university hospital. Patients: Consecutive series of 101 patients admitted to the intensive care unit immediately after elective hepatectomy for biliary tract carcinoma. Interventions: None. Measurements and Main Results: APACHE II and APACHE III scores were calculated on postoperative days 1, 2, and 3. The 101 subjects were classified into three groups: a) survivors without posthepatectomy liver failure (n = 69); b) survivors with liver failure (n = 17); and c) nonsurvivors with liver failure (n = 15). APACHE III, but not APACHE II, was significantly different between the three groups at all time points. An increased APACHE III score correlated with an increased risk of death, while death did not correlate with APACHE II score. Conclusion: In posthepatectomy patients with biliary tract carcinoma, APACHE III, unlike APACHE II, is sufficiently reliable for clinical use to stratify patients and predict mortality.