Implementation and first results of a mandatory, nationwide audit on liver surgery

Abstract

Background: The Dutch Hepato Biliary Audit (DHBA) was initiated in 2013 to assess the national quality of liver surgery. This study aimed to describe the initiation and implementation of this audit along with an overview of the results and future perspectives. Methods: Registry of patients undergoing liver surgery for all primary and secondary liver tumors in the DHBA is mandatory. Weekly, benchmarked information on process and outcome measures is reported to surgical teams. In this study, the first results of patients with colorectal liver metastases were presented, including results of data verification.Results: Between 2014 and 2017, 6241 procedures were registered, including 4261 (68%) resections for colorectal liver metastases. For minor-and major liver resections for colorectal liver metastases, the median [interquartile range] hospital stay was 6 [4-8] and 8 [6-12] days, respectively. A postoperative complicated course (complication leading to >14 days of hospital stay, reintervention or death) occurred in 26% and 43% and the 30-day/in-hospital mortality was 1% and 4%, respectively. The completeness of data was 97%. In 3.6% of patients, a complicated postoperative course was erroneously omitted. Conclusion:Nationwide implementation of the DHBA has been successful. This was the first step in creating a complete evaluation of the quality of liver surgery.

Enhanced recovery after surgery programmes in older patients undergoing hepatopancreatobiliary surgery: what benefits might prehabilitation have?

“…However, HPB surgery is an invasive treatment and perioperative morbidity is high, especially for large and complex pancreatic and hepatic procedures. A recent study in patients registered in the obligatory national Dutch audit reported that 43% of the patients had a complicated postoperative course after major liver resection (3 segments) and 26% after minor liver resection (<3 segments) performed for colorectal liver metastasis [6]. Additionally, the Dutch Institute for Clinical Auditing (DICA) reported that between 2014 and 2018, 29% of the patients who underwent a pancreatoduodenectomy in the Netherlands developed a major complication (Clavien-Dindo grade 3) [7].…”

Reorganizing the Multidisciplinary Team Meetings in a Tertiary Centre for Gastro-Intestinal Oncology Adds Value to the Internal and Regional Care Pathways. A Mixed Method Evaluation

“…Additionally, there remains a dilemma for the hepatobiliary pathway. The efficiency of the care pathway in terms of diagnostic procedures against the importance of meeting the patient before making a treatment plan at the MDTM so that the patient’s wishes concerning treatment can get more attention and can be optimally included [ 59 ].…”

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

“…Surgery is an important treatment modality for patients with liver or pancreatic tumors; however, perioperative morbidity is high, especially in patients scheduled for liver or pancreatic surgery with a low aerobic fitness. 1,2,4,5 Enhancing preoperative physical fitness of these high-risk patients may improve their postoperative outcomes. Dunne et al showed that a four-week supervised hospitalbased exercise prehabilitation program improved the VO 2 at the ventilatory anaerobic threshold on average with 1.5 ml/kg/min (p=0.023) before liver resection in the intervention group, with no statistically significant difference in any postoperative outcomes compared to the control group.…”

“…A recent study reported that 43% of the patients had a complicated postoperative course after major liver resection (≥3 segments) and 26% after a minor liver resection (<3 segments) for colorectal liver metastasis. 1 Additionally, the Dutch Institute for Clinical Auditing (DICA) reported that between 2014 and 2018, 29% of the patient's developed a major complication after pancreaticoduodenectomy. 2 Preoperative aerobic fitness has been found to have a consistent relation with postoperative outcome after major elective intra-abdominal surgery (e.g., morbidity).…”