Predictors of Postoperative Morbidity in Pediatric Liver Hydatid Disease: Role of Comorbidities and Multisite Infection

Background Postoperative morbidity remains a significant concern following the surgical treatment of pediatric liver hydatid disease, particularly in endemic regions. The aim of this study was to identify independent predictors of postoperative morbidity in pediatric liver hydatid disease in order to improve preoperative risk assessment. Methods This retrospective observational study included consecutive pediatric patients who underwent surgical treatment for liver hydatid disease at Hedi Chaker University Hospital, Sfax, Tunisia, between 1 July 2010 and 30 June 2025. Postoperative morbidity was defined as any complication occurring within 30 days after surgery. Results A total of 117 children were included. The median age was 8 years, with a nearly equal sex distribution (59 males and 58 females). The median Sun Pediatric Comorbidity Index (SPCI) was 1 [IQR, 0–2]. The mean cyst size was 8 ± 2.4 cm, with right lobe involvement observed in 83 patients (70.9%). Concomitant extrahepatic hydatid disease was identified in 23 children (19.7%). Postoperative complications occurred in 25 patients (21.4%). In multivariate analysis, three factors were independently associated with postoperative morbidity: SPCI ≥ 3 (OR 5.748, 95% CI 1.696–19.482; p = 0.005), cyst size > 8 cm (OR 5.020, 95% CI 1.172–21.513; p = 0.030), and concomitant extrahepatic hydatid disease (OR 6.355, 95% CI 1.710–23.620; p = 0.006). Conclusion Postoperative morbidity after pediatric liver hydatid surgery remains frequent. Beyond cyst size, pediatric comorbidity burden and multisite hydatid disease emerge as novel and independent predictors of adverse postoperative outcomes.