Predictive factors of postoperative morbidity and mortality after surgical treatment of hepatic hydatid cysts

Abstract

Hepatic hydatid cyst remains a major public health problem in endemic regions, where postoperative complications are still frequent despite advances in surgical techniques. Identifying predictive factors of postoperative morbidity and mortality is essential to improve perioperative management. This retrospective descriptive and analytical study was conducted at the University Hospital of Bizerte between January 2022 and December 2024. Fifty patients who underwent surgery for a single hepatic hydatid cyst were included. Clinical, biological, radiological, intraoperative, and postoperative variables were analyzed. Factors associated with postoperative morbidity and mortality were evaluated using univariate and multivariate logistic regression analyses. Postoperative morbidity occurred in 28% of patients, and postoperative mortality was 2%. The most frequent complications were deep surgical site infections (20%), biliary fistulas (10%), and wound infections (10%). Independent predictors of postoperative morbidity and mortality were preoperative fever, cyst size greater than 10 cm, elevated C-reactive protein levels, intraoperative biliary content, cysto-biliary fistula, postoperative biliary fistula, residual cavity suppuration, prolonged drainage (> 7 days), and intensive care unit stay. Postoperative morbidity after surgery for hepatic hydatid cyst remains substantial and is mainly related to infectious and biliary factors. Early identification of high-risk patients, systematic intraoperative exploration of biliary communications, and tailored surgical strategies are essential to reduce postoperative complications in endemic regions.