TY - JOUR
T1 - Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery
AU - Görgec, Burak
AU - Benedetti Cacciaguerra, Andrea
AU - Lanari, Jacopo
AU - Russolillo, Nadia
AU - Cipriani, Federica
AU - Aghayan, Davit
AU - Zimmitti, Giuseppe
AU - Efanov, Mikhail
AU - Alseidi, Adnan
AU - Mocchegiani, Federico
AU - Giuliante, Felice
AU - Ruzzenente, Andrea
AU - Rotellar, Fernando
AU - Fuks, David
AU - D'Hondt, Mathieu
AU - Vivarelli, Marco
AU - Edwin, Bjørn
AU - Aldrighetti, Luca A.
AU - Ferrero, Alessandro
AU - Cillo, Umberto
AU - Besselink, Marc G.
AU - Abu Hilal, Mohammed
N1 - Publisher Copyright: © 2021 American Medical Association. All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - Importance: Textbook outcome (TO) is a composite measure that captures the most desirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR). Objective: To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a large international multicenter database using a propensity-score matched analysis. Design, Setting, and Participants: Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated. Main Outcomes and Measures: Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications, readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin. Results: A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P <.001). On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases (odds ratio [OR], 0.656 [95% CI, 0.457-0.940]; P =.02), cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments (OR, 0.716 [95% CI, 0.577-0.887]; P =.002), anatomically major resection (OR, 0.579 [95% CI, 0.418-0.803]; P =.001), and nonanatomical resection (OR, 0.612 [95% CI, 0.476-0.788]; P <.001) were associated with a worse TOLS rate after LLR. For OLR, only histological diagnosis of cholangiocarcinoma (OR, 0.360 [95% CI, 0.214-0.607]; P <.001) and a tumor size of 30 mm or more (30-50 mm = OR, 0.718 [95% CI, 0.565-0.911]; P =.01; 50.1-100 mm = OR, 0.729 [95% CI, 0.554-0.960]; P =.02; >10 cm = OR, 0.550 [95% CI, 0.366-0.826]; P =.004) were associated with a worse TOLS rate. Conclusions and Relevance: In this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.
AB - Importance: Textbook outcome (TO) is a composite measure that captures the most desirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR). Objective: To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a large international multicenter database using a propensity-score matched analysis. Design, Setting, and Participants: Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated. Main Outcomes and Measures: Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications, readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin. Results: A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P <.001). On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases (odds ratio [OR], 0.656 [95% CI, 0.457-0.940]; P =.02), cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments (OR, 0.716 [95% CI, 0.577-0.887]; P =.002), anatomically major resection (OR, 0.579 [95% CI, 0.418-0.803]; P =.001), and nonanatomical resection (OR, 0.612 [95% CI, 0.476-0.788]; P <.001) were associated with a worse TOLS rate after LLR. For OLR, only histological diagnosis of cholangiocarcinoma (OR, 0.360 [95% CI, 0.214-0.607]; P <.001) and a tumor size of 30 mm or more (30-50 mm = OR, 0.718 [95% CI, 0.565-0.911]; P =.01; 50.1-100 mm = OR, 0.729 [95% CI, 0.554-0.960]; P =.02; >10 cm = OR, 0.550 [95% CI, 0.366-0.826]; P =.004) were associated with a worse TOLS rate. Conclusions and Relevance: In this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.
UR - http://www.scopus.com/inward/record.url?scp=85107845710&partnerID=8YFLogxK
U2 - https://doi.org/10.1001/jamasurg.2021.2064
DO - https://doi.org/10.1001/jamasurg.2021.2064
M3 - Article
C2 - 34076671
SN - 2168-6254
VL - 156
JO - Jama surgery
JF - Jama surgery
IS - 8
M1 - e212064
ER -