An increased area deprivation index (ADI) correlates with a higher risk of 90-day mortality after major hepatectomy, particularly due to posthepatectomy liver failure.

• Patients in the upper tier of ADI had a 5.47-fold increased risk of 90-day mortality (p = .043) compared to lower tiers.
• 4.9% of patients died within 90 days post-surgery, predominantly from liver failure.
• Morbidity was associated with factors like hepaticojejunostomy and cholangiocarcinoma but not with ADI.

Surgeons should consider using ADI in preoperative assessments to better prepare high-risk patients.