A core set of quality performance indicators for HPB procedures: a global consensus for hepatectomy, pancreatectomy, and complex biliary surgery

Woodhouse, Braden J.; Stavrou, Gregor A.; Teh, Catherine; Herman, Paulo; Berrevoet, Frederik; Talamonti, Mark S.; Mikhnevich, Mikhail; Søreide, Kjetil; Khatkov, Igor; Webber, Laurence; Калдаров, А. Р.; Windsor, John; Filho, Omero P. Costa; Teh, Catherine; Pitt, Henry A.; Stavrou, Gregor A.; Barreto, Savio George; Martino, Marcello Di; López-López, Víctor; Koea, Jonathan

doi:10.1016/j.hpb.2023.04.009

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…As previously mentioned, numerous factors contribute to safety, and in the recent times, the assessment of the quality of a specific surgical procedure is gaining increasing attention from international surgical associations. Woodhouse et al [ 45 ] have recently formulated a set of globally accepted quality performance indicators (QPIs) for hepato-pancreato-biliary procedures. Through a modified Delphi process, three rounds of consultations were conducted with working groups comprising members of the International Hepato-Pancreato-Biliary Association (IHPBA).…”

Section: Resultsmentioning

confidence: 99%

“…The increased demands for quality assessment in liver surgery together with the expected increasing incidence of primary liver tumors in the next few years [ 11 , 45 ], justified the need to conduct research studies of this type.…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, surgeon credentialing should reflect real-world practice data rather than arbitrary benchmarks [ 51 , 52 ]. A more comprehensive quality measure would come by the diffusion of the new QPIs recently proposed by the IHPBA that being a summary of composite outcomes approved by an international committee should give back a more reliable quality tool [ 45 ]. What is still missing in all these types of outcome measures and quality metrics proposed, is the metric around the patient.…”

Section: Discussionmentioning

confidence: 99%

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6,126 hepatectomies in 2022: current trend of outcome in Italy

Nicolazzi,

Di Martino,

Baroffio

et al. 2024

Langenbecks Arch Surg

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Purpose Whether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume. Methods This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry “Piano Nazionale Esiti” (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added. Results 6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively). Conclusions High-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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6,126 hepatectomies in 2022: current trend of outcome in Italy

Nicolazzi,

Di Martino,

Baroffio

et al. 2024

Langenbecks Arch Surg

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“…This challenge of providing high quality complex surgical care in low-volume environments also faces other developed countries with populations of less than 6 million 1 making it a global issue and means that pure volume alone cannot be the only driver of excellence in surgical care. 33 AUTHOR CONTRIBUTIONS Jonathan Koea: Conceptualization; funding acquisition; administration; software; original draft. Phillip Chao: Conceptualization; funding acquisition; administration; software; validation; original draft; review and editing.…”

Section: Discussionmentioning

confidence: 99%

“…New Zealand's challenge is to develop and implement a system that optimizes the skills and pathways that comes from frequent performance of a complex task but maintains system resilience and ensures equitable access for all patients. This challenge of providing high quality complex surgical care in low‐volume environments also faces other developed countries with populations of less than 6 million 1 making it a global issue and means that pure volume alone cannot be the only driver of excellence in surgical care 33 …”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume‐outcome relationship with accessibility in a surgically low volume country

Koea,

Chao,

Srinivasa

et al. 2024

World j. surg.

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IntroductionNew Zealand has a population of only 5.5 million meaning that for many surgical procedures the country qualifies as a “low‐volume center.” However, the health system is well developed and required to provide complex surgical procedures that benchmark internationally against comparable countries. This investigation was undertaken to review regional variation and volumes of complex resection and palliative upper gastrointestinal (UGI) surgical procedures within New Zealand.MethodsData pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset.ResultsNew Zealand is a low‐volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid‐Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Māori were less likely to be treated in a nationally designated cancer center than non‐Māori.ConclusionsThe challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients.

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A critical analysis of surgical outcomes indicators in hepato‐pancreato‐biliary surgery: From crude mortality to composite outcomes

Di Martino,

Nicolazzi,

Baroffio

et al. 2024

World j. surg.

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BackgroundIndicators of surgical outcomes are designed to objectively evaluate surgical performance, enabling comparisons among surgeons and institutions. In recent years, there has been a surge in complex indicators of perioperative short‐term and long‐term outcomes. The aim of this narrative review is to provide an overview and a critical analysis of surgical outcomes indicators, with a special emphasis on hepato‐pancreato‐biliary (HPB) surgery.MethodsA narrative review of outcome measures was conducted using a combined text and MeSH search strategy to identify relevant articles focused on perioperative outcomes, specifically within HPB surgery.ResultsThe literature search yielded 624 records, and 94 studies were included in the analysis. Included papers were classified depending on whether they assessed intraoperative or postoperative specific or composite outcomes, and whether they assessed purely clinical or combined clinical and socio‐economic indicators. Specific indicators included in composite outcomes were categorized into three main domains: intraoperative metrics, postoperative outcomes, and oncological outcomes. While postoperative mortality, complications, hospital stay and readmission were the indicators most frequently included in composite outcomes, oncological outcomes were rarely considered.ConclusionsThe evolution of surgical outcomes has shifted from the simplistic assessment of crude mortality rates to complex composite outcomes. Whether the recent explosion of publications on these topics has a clinical impact in real life is questionable. Outcomes from the patient perspective, integrating social and financial indicators, are not yet integrated into most of these composite analytical tools but should not be underestimated.

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A core set of quality performance indicators for HPB procedures: a global consensus for hepatectomy, pancreatectomy, and complex biliary surgery

Cited by 8 publications

References 34 publications

6,126 hepatectomies in 2022: current trend of outcome in Italy

6,126 hepatectomies in 2022: current trend of outcome in Italy

Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume‐outcome relationship with accessibility in a surgically low volume country

A critical analysis of surgical outcomes indicators in hepato‐pancreato‐biliary surgery: From crude mortality to composite outcomes

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