Defining Textbook Outcome in liver surgery and assessment of hospital variation: A nationwide population-based study |
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Institution: | 1. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands;2. Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands;3. Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;4. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands;5. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;6. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands;7. Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands;8. Department of Surgery, Radboud Medical Center, Nijmegen, the Netherlands;9. Department of Surgery, Amphia Medical Center, Breda, the Netherlands;10. Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands;11. Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands;12. Department of Surgery, Antoni van Leeuwenhoek – Dutch Cancer Institute, Amsterdam, the Netherlands;13. Department of Surgery, OLVG, Amsterdam, the Netherlands;14. Department of Surgery, Isala, Zwolle, the Netherlands;15. Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands |
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Abstract: | IntroductionTextbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery.MethodsThis was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment.Results2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51–0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44–0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34–0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54–0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36–0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed.ConclusionTO differs between indications for liver resection and can be used to assess between hospital and network differences. |
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Keywords: | Liver surgery Textbook outcome Quality indicator Hospital variation Clinical auditing |
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