Textbook outcome among voluntary donors undergoing major living donor hepatectomy

Abstract

Purpose Textbook outcome (TO) is a composite measure of outcome and provides superior assessment of quality of care after surgery. TO after major living donor hepatectomy (MLDH) has not been assessed. The objective of this study was to determine the rate of TO and its associated factors, after MLDH. Methods This was a single center retrospective review of living liver donors who underwent MLDH between 2012 and 2021 ( n = 1022). The rate of TO and its associated factors was determined. Results Among 1022 living donors (of whom 693 [67.8%] were males, median age 26 [range, 18–54] years), TO was achieved in 714 (69.9%) with no donor mortality. Majority of donors met the cutoffs for individual outcome measures: 908 (88.8%) for no major complications, 904 (88.5%) for ICU stay ≤ 2 days, 900 (88.1%) for hospital stay ≤ 10 days, 990 (96.9%) for no perioperative blood transfusion, 1004 (98.2%) for no 30-day re-admission, and 1014 (99.2%) for no post-hepatectomy liver failure. Early donation era (before streamlining of donor operative pathways) was associated with failure to achieve TO [OR 1.4, CI 1.1–1.9, P = 0.006]. TO was achieved in 506/755 (67%) donors in the early donation era versus 208/267 (77.9%) in the later period ( P = 0.001). Conclusion Despite zero mortality and low complication rate, TO was achieved in approximately 70% donors. TO was modifiable and improved with changes in donor operative pathway.

Textbook Outcomes After Open Live Donor Right Hepatectomy and Open Right Hepatic Lobectomy for Cancer in 686 patients

“…Another major finding is this study is that TO was achieved in the overwhelming majority (92.2%) of patients who underwent living donor right hepatic lobectomy. This is significantly higher than previously reported by Bhatti et al 4 who found that 69.4% of right lobe donor hepatectomy patients achieved a TO, and which to our knowledge is the only other study to report TO in this surgical population. Moreover, Rössler et al 18 reviewed 4206 living donor right hepatectomies and reported on individual outcome parameters in an effort to serve as a benchmark for hepatic surgery, but they did not utilize a composite outcome measure.…”

“…An additional quality improvement tool is benchmarking, which attempts to identify the best-achievable outcomes for a specific surgical procedure 5,15–17 . In the field of hepatic surgery, live donor hepatectomy has been proposed as a unique model to benchmark hepatic resections, as the anticipated morbidity of liver donation should be low and mortality should be negligible 4,18 . A recent study reported that TO was achieved in 70% of patients undergoing major live donor hepatectomy, including both right and left hepatic lobectomy 4 …”

“…"Textbook outcome" (TO) is one such composite quality measure that was first introduced in 2013 in a colorectal cancer surgery series from the Netherlands and has since been assessed in various additional surgical fields, including esophagogastric, transplantation, pancreatic, and hepatobiliary surgery. [2][3][4][5][6][7][8] TO analysis has been used as an effective means of health system level comparison of patient-centered perioperative care. 9,10 Among patients undergoing liver resection, reported TOs vary greatly between 25.5 and 62.3%, and none of the previous studies have specifically focused on open right hepatic lobectomy for cancer or live donor hepatectomy.…”

Outcomes of hepaticojejunostomy for post-cholecystectomy bile duct injury

“…Familiarity with the porta hepatis during donor and recipient operations and small duct-to-duct biliary anastomoses using 7/0 sutures may have been responsible for these outcomes. [33][34][35] Liver resection is required in only 0.8% to 1.4% patients with complex vasculobiliary injury or proximal BDI. 12,17 A recent systematic review showed that only 67 patients underwent right hepatectomy for BDI.…”

“…Familiarity with the porta hepatis during donor and recipient operations and small duct-to-duct biliary anastomoses using 7/0 sutures may have been responsible for these outcomes. 33 – 35 …”