TY - JOUR
T1 - Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases
AU - Elfrink, Arthur K. E.
AU - van Zwet, Erik W.
AU - Swijnenburg, Rutger-Jan
AU - den Dulk, Marcel
AU - van den Boezem, Peter B.
AU - Mieog, J. Sven D.
AU - te Riele, Wouter W.
AU - Patijn, Gijs A.
AU - Leclercq, Wouter K. G.
AU - Lips, Daan J.
AU - Rijken, Arjen M.
AU - Verhoef, Cornelis
AU - Kuhlmann, Koert F. D.
AU - Buis, Carlijn I.
AU - Bosscha, Koop
AU - Belt, Eric J. T.
AU - Vermaas, Maarten
AU - van Heek, N. Tjarda
AU - Oosterling, Steven J.
AU - Torrenga, Hans
AU - Eker, Hasan H.
AU - Consten, Esther C. J.
AU - Marsman, Hendrik A.
AU - Wouters, Michel W. J. M.
AU - Kok, Niels F. M.
AU - Grünhagen, Dirk J.
AU - Klaase, Joost M.
AU - Dutch Hepato Biliary Audit Group
AU - Besselink, Marc G. H.
AU - de Boer, Marieke T.
AU - Dejong, Cees H. C.
AU - van Gulik, Thomas M.
AU - Hagendoorn, Jeroen
AU - Hoogwater, Frederik H. J.
AU - Molenaar, I. Quintus
AU - Liem, Mike S. L.
N1 - Publisher Copyright: © 2020 University Medical Center Groningen Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM). Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019. Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%–17.1%, p < 0.001), ASA 3 or higher (3.3%–36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%–47.1%, p < 0.001), history of liver resection (8.1%–36.3%, p < 0.001), major liver resection (6.7%–38.0%, p < 0.001) and synchronous metastases (35.5%–62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes. Conclusion: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM.
AB - Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM). Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019. Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%–17.1%, p < 0.001), ASA 3 or higher (3.3%–36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%–47.1%, p < 0.001), history of liver resection (8.1%–36.3%, p < 0.001), major liver resection (6.7%–38.0%, p < 0.001) and synchronous metastases (35.5%–62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes. Conclusion: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM.
UR - http://www.scopus.com/inward/record.url?scp=85095858983&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2020.10.016
DO - https://doi.org/10.1016/j.ejso.2020.10.016
M3 - Article
C2 - 33183927
SN - 0748-7983
VL - 47
SP - 649
EP - 659
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 3
ER -