TY - JOUR
T1 - Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes
T2 - a nationwide population-based study
AU - Dutch Hepato Biliary Audit Group
AU - Collaborators
AU - Elfrink, Arthur K.E.
AU - Nieuwenhuizen, Sanne
AU - van den Tol, M. Petrousjka
AU - Burgmans, Mark C.
AU - Prevoo, Warner
AU - Coolsen, Marielle M.E.
AU - van den Boezem, Peter B.
AU - van Delden, Otto M.
AU - Hagendoorn, Jeroen
AU - Patijn, Gijs A.
AU - Leclercq, Wouter K.G.
AU - Liem, Mike S.L.
AU - Rijken, Arjen M.
AU - Verhoef, Cornelis
AU - Kuhlmann, Koert F.D.
AU - Ruiter, Simeon J.S.
AU - Grünhagen, Dirk J.
AU - Klaase, Joost M.
AU - Kok, Niels F.M.
AU - Meijerink, Martijn R.
AU - Swijnenburg, Rutger Jan
AU - te Riele, Wouter W.
AU - de Boer, Marieke T.
AU - Dejong, Cees H.C.
AU - van Gulik, Thomas H.
AU - Hoogwater, Frederik J.H.
AU - Molenaar, I. Q.
AU - van der Leij, Christiaan
AU - Moelker, Adriaan
AU - Besselink, Marc G.H.
AU - Buis, Carlijn I.
AU - den Dulk, Marcel
AU - Bosscha, Koop
AU - Belt, Eric J.Th
AU - Vermaas, Maarten
AU - van Heek, Tjarda N.T.
AU - Oosterling, Steven J.
AU - Torrenga, Hans
AU - Eker, Hasan H.
AU - Consten, Esther C.J.
N1 - Publisher Copyright: © 2020 University Medical Center Groningen
PY - 2021/6
Y1 - 2021/6
N2 - Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.
AB - Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.
UR - http://www.scopus.com/inward/record.url?scp=85096894066&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.hpb.2020.10.003
DO - https://doi.org/10.1016/j.hpb.2020.10.003
M3 - Article
C2 - 33218949
SN - 1365-182X
VL - 23
SP - 827
EP - 839
JO - HPB
JF - HPB
IS - 6
ER -