Predictors of Postoperative Complications Following Surgery for Abdominal Hydatid Cysts: A Retrospective Cohort Study from a Tertiary Center in Yemen

Predictors of Postoperative Complications Following Surgery for Abdominal Hydatid Cysts

Abstract

Background: Surgery for abdominal hydatid cysts is frequently complicated by high rates of postoperative morbidity including infections and biliary fistulas. In resource-limited settings such as Yemen, this burden is amplified. The ability to preemptively identify patients at high risk for complications is critical for tailoring surgical strategies and optimizing care; however, validated predictive tools for this specific patient population are lacking.

Aim: This study aimed to identify the preoperative and intraoperative predictors of major postoperative complications following surgery for cystic echinococcosis (CE) and to develop a clinical risk score for patient stratification in a resource-limited setting.

Methods: We conducted a retrospective cohort study of 103 patients who underwent surgery for intra-abdominal CE at a tertiary referral center in Yemen. Data on patient demographics, clinical factors, radiological cyst characteristics, and surgical details were collected. The primary outcome was a composite of major postoperative complications. A multivariate logistic regression model with backward stepwise selection was used to identify the independent risk factors that were subsequently used to construct a clinical risk score.

Results: Major postoperative complications occurred in 44 of 103 patients (42.7%). The final multivariate model identified two independent predictors of complications: preoperative leukocytosis (odds ratio [OR] = 3.38; 95% confidence interval (CI) 1.37-8.33) and increasing cyst size category (OR = 2.40; 95% CI: 0.97-5.97). Based on these predictors, a clinical risk score was developed to effectively stratify the patients into low- (59 patients, 25.4% complication rate), medium- (33 patients, 66.7% complication rate), and high-risk (11 patients, 63.6% complication rate) groups.

Conclusion: Postoperative morbidity after surgery for CE is significant. Preoperative leukocytosis and a larger cyst size are key independent risk factors for adverse outcomes. The clinical risk score developed in this study is a simple, practical tool that can aid surgeons in preoperative risk assessment and guide clinical decision making to improve patient outcomes.