Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

Elfrink, Arthur K.E.; Zwet, Erik W. van; Swijnenburg, Rutger-Jan; Dulk, Marcel den; Boezem, Peter B. van den; Mieog, J. Sven D.; Riele, Wouter W. te; Patijn, Gijs A.; Leclercq, Wouter K G; Lips, Daan J.; Rijken, Arjen M.; Verhoef, Cornelis; Kuhlmann, Koert F. D.; Buis, Carlijn I.; Bosscha, K.; Belt, Eric; Vermaas, Maarten; Heek, N. Tjarda van; Oosterling, Steven J.; Torrenga, Hans; Eker, Hasan Hüseyin; Consten, Esther C. J.; Marsman, Hendrik A.; Wouters, Michel W.J.M.; Kok, Niels F. M.; Grünhagen, Dirk J.; Klaase, Joost M.; Besselink, Marc G.; Boer, Marieke T. de; Dejong, C. H. C.; Gulik, Thomas M. van; Hagendoorn, Jeroen; Hoogwater, Frederik H.J.; Molenaar, I. Quintus; Liem, Mike S L

doi:10.1016/j.ejso.2020.10.016

Cited by 20 publications

(24 citation statements)

References 39 publications

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“…7,19e21 A future study could aim to develop a case-mix adjustment model to more properly compare morbidity and mortality in patients after TP, as was recently done for patients who underwent liver resection for colorectal liver metastases. 22 Case-mix factors for patients who underwent pancreatic surgery were already identified from a systematic literature search, and the most important factors were selected after multidisciplinary and international discussions. 10 The presence of high-volume centers in the United States and advanced centralization in Sweden could explain the lower inhospital mortality.…”

Section: Discussionmentioning

confidence: 99%

The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

Latenstein

Mackay

Beane³

et al. 2021

Surgery

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Background: Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods: Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014e2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatoduodenectomy. Primary outcomes were major morbidity (Clavien Dindo 3) and in-hospital mortality. Predictors for the primary outcomes were assessed in multivariable logistic regression analyses. Sensitivity analysis assessed the impact of volume (low-volume <40 or high-volume 40 pancreatoduodenectomies annually; data available for the Netherlands and Germany). Results: In total, 1,579 patients underwent one-stage total pancreatectomy. The relative use of total pancreatectomy to pancreatoduodenectomy varied up to fivefold (United States 0.03, Germany 0.15, the Netherlands 0.03, and Sweden 0.15; P < .001). Both the indication and several baseline characteristics differed significantly among countries. Major morbidity occurred in 423 patients (26.8%) and differed (22.3%, 34.9%, 38.3%, and 15.9%, respectively; P < .001). In-hospital mortality occurred in 85 patients (5.4%) and also differed (1.8%, 10.2%, 10.8%, 1.9%, respectively; P < .001). Country, age 75, and vascular resection were predictors for in-hospital mortality. In-hospital mortality was lower in high-volume centers in the Netherlands (4.9% vs 23.1%; P ¼ .002), but not in Germany (9.8% vs 10.6%; P ¼ .733). Conclusion: Considerable differences in the use of total pancreatectomy, patient characteristics, and postoperative outcome were noted among 4 Western countries with better outcomes in the United States and Sweden. These large, yet unexplained, differences require further research to ultimately improve patient outcome.

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Section: Discussionmentioning

confidence: 99%

The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

Latenstein

Mackay

Beane³

et al. 2021

Surgery

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“…Variables used were sex, age, American Society of Anesthesiologist (ASA) classification, Body Mass Index (BMI), comorbidity scores classified according to the Charlson Comorbidity Score (CCI), histopathological classification of liver parenchyma adjacent to tumour tissue, previous liver surgery and diameter of the largest tumour before the initiation of tumour-specific treatment. 15 Treatment characteristics included use of preoperative chemotherapy, minor or major liver resection, and type of hospital where treatment took place which was either a tertiary referral center or regional hospital. Major liver resection was defined as resection of three or more Couinaud segments.…”

Section: Variablesmentioning

confidence: 99%

Short-term postoperative outcomes after liver resection in the elderly patient: a nationwide population-based study

Elfrink

Kok

Dulk

et al. 2021

HPB

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Background: Liver resection is high-risk surgery in particular in elderly patients. The aim of this study was to explore postoperative outcomes after liver resection in elderly patients.Methods: In this nationwide study, all patients who underwent liver resection for primary and secondary liver tumours in the Netherlands between 2014 and 2019 were included. Age groups were composed as younger than 70 (70-), between 70 and 80 (septuagenarians), and 80 years or older (octogenarians).Proportion of liver resections per age group and 30-day major morbidity and 30-day mortality were assessed. Results: In total, 6587 patients were included of whom 4023 (58.9%) were younger than 70, 2135 (32.4%) were septuagenarians and 429 (6.5%) were octogenarians. The proportion of septuagenarians increased during the study period (aOR:1.06, CI:1.02-1.09, p < 0.001). Thirty-day major morbidity was higher in septuagenarians (11%) and octogenarians (12%) compared to younger patients (9%, p = 0.049). Thirty-day mortality was higher in septuagenarians (4%) and octogenarians (4%) compared to younger patients (2%, p < 0.001). Cardiopulmonary complications occurred more frequently with higher age, liver-specific complications did not. Higher age was associated with higher 30-day morbidity and 30-day mortality in multivariable logistic regression. Conclusion: Thirty-day major morbidity and 30-day mortality are higher after liver resection in elderly patients, attributed mainly to non-surgical cardiopulmonary complications.

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“…Postoperative mortality among patients who undergo liver resection for colorectal liver metastases (CRLM) or liver metastases from other tumour types has been described to be near 5%. [8][9][10] Mortality among patients with primary liver cancers such as hepatocellular carcinoma (HCC) and biliary cancer have been reported to be even higher, approximately 5-10% and 10-20% respectively. [11][12][13][14] Improving complication management could lead to reducing postoperative mortality.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study

Elfrink

Olthof

Swijnenburg

et al. 2021

HPB

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Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

Cited by 20 publications

References 39 publications

The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

Short-term postoperative outcomes after liver resection in the elderly patient: a nationwide population-based study

Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study

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