Quality performance indicators for hepato-pancreatico-biliary procedures: a systematic review

Woodhouse, Braden J.; Panesar, Divyansh; Koea, Jonathan

doi:10.1016/j.hpb.2020.10.013

Cited by 6 publications

(4 citation statements)

References 63 publications

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“…Pancreas resection was associated with 73% decreased odds of TO achievement among patients who underwent surgical resection for IPNB. High morbidity associated with pancreatic-intestinal anastomosis (fistula, hemorrhage, infection) could explain the worse TO of pancreatic resection compared to hepatic resection 32 . Pancreatic duct diameter and pancreatic parenchyma texture, two characteristics associated with pancreatic fistula, were not recorded in our study.…”

Section: Discussionmentioning

confidence: 99%

Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)

Lluís

Serradilla-Martín

Boira

et al. 2023

International Journal of Surgery

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Background/Purpose: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. Methods: A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien–Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. Results: A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55–72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50–82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 (P=0.016), intrahepatic versus extrahepatic tumor (P=0.027), single versus multiple tumors (P=0.007), those who underwent hepatic versus pancreatic resection (P=0.017), or achieved versus failed TO (P=0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11–15.94; P=0.03) was an independent prognostic factor of poor overall survival. Conclusions: Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.

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Section: Discussionmentioning

confidence: 99%

Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)

Lluís

Serradilla-Martín

Boira

et al. 2023

International Journal of Surgery

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“…However, there is still no agreement among experts on precise criteria on what to centralize, where to centralize, and who should be entitled to perform complex procedures such as hepatobiliary surgery [ 5 ]. Besides, there is still no agreement on which outcome measures should be considered to assess quality and safety in surgery [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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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“…These QPI's may be utilized to identify characteristics of high performing providers across jurisdictions, drive quality improvement, and develop benchmarking standards for the delivery of health care within communities. 1 Measuring patient outcomes and defining optimal treatment pathways in cancer is complex and must consider each part of the patient journey from initial presentation, diagnosis, staging, treatment and post-treatment care in order to establish what an 'ideal' treatment pathway should resemble. Importantly, QPIs attempt to capture significant aspects of patient care along this pathway, provide an opportunity to objectively measure accomplishment and provide a foundation for specific quality improvement initiatives.…”

Section: Introductionmentioning

confidence: 99%

“…Quality performance indicators (QPI) are objective measurements that are used to monitor and improve elements of patient care that are fundamental to overall outcome. These QPI's may be utilized to identify characteristics of high performing providers across jurisdictions, drive quality improvement, and develop benchmarking standards for the delivery of health care within communities 1 . Measuring patient outcomes and defining optimal treatment pathways in cancer is complex and must consider each part of the patient journey from initial presentation, diagnosis, staging, treatment and post‐treatment care in order to establish what an ‘ideal’ treatment pathway should resemble.…”

Section: Introductionmentioning

confidence: 99%

Quality performance indicators for the surgical treatment of gastric adenocarcinoma: a systematic review

Kulasegaran

Woodhouse

MacCormick

et al. 2022

ANZ Journal of Surgery

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Background: A systematic review was undertaken to identify existing quality performance indicators (QPI) for the surgical treatment of gastric adenocarcinoma (GA) with the aim of defining a set of QPIs that can be used to assist in the accreditation of institutions for training, allow cross jurisdiction comparison of treatment and outcomes, as well as provide a basis to develop quality improvement programs. These QPI's capture key components of patient care that are fundamental to overall outcome. Methods: A systematic literature review was conducted searching MEDLINE, PubMed, EMBASE, and SCOPUS with all literature available until the date of 1 August 2021 included. Search terms utilized were 'Quality of health care OR Quality improvement or Quality control OR Quality indicators', AND 'Gastrectomy' OR 'Stomach neoplasm' OR 'Adenocarcinoma' OR 'Gastric resection' OR 'Gastric cancer'. Results: Twelve articles were included in the final analysis. The selected studies included editorials (n = 2), retrospective review of institutional experience (n = 5), cohort studies (n = 2), survey methodology (n = 1), expert guidelines (n = 1) and consensus statement (n = 1). For GC QPIs, process measures included patient discussion at multi-disciplinary meetings, access to perioperative multimodal diagnostic pathways, and specific surgical metrics (margin negative resections and adequate lymphadenectomy). Outcome measures included the RO resection rate, reoperation, readmission rate, and length of hospital stay. Conclusions: There is a relative paucity of internationally agreed QPI for the surgical management of gastric adenocarcinoma. The data from this review will form the basis of a project to develop internationally agreed and feasible QPI for gastric cancer resections.

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Quality performance indicators for hepato-pancreatico-biliary procedures: a systematic review

Cited by 6 publications

References 63 publications

Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)

Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)

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

Quality performance indicators for the surgical treatment of gastric adenocarcinoma: a systematic review

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