Textbook Outcomes in Liver Surgery: a Systematic Review

Sweigert, Patrick J.; Ramia, José Manuel; Villodre, C.; Morote, Silvia Carbonell; De-la-Plaza, Roberto; Serradilla, M.; Pawlik, Timothy M.

doi:10.1007/s11605-023-05673-1

Cited by 9 publications

(4 citation statements)

References 52 publications

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“…While the definition of textbook outcomes may differ based on the surgery type, it typically encompasses patients who do not encounter mortality, severe complications, readmission, and exhibit favorable surrogate oncological parameters. Numerous recent studies have focused on evaluating textbook outcomes in liver surgery [ 36 , 38 – 42 ]. In 2021 Görgec et al [ 39 ] published the findings of an international multicentric clinical study on textbook outcomes (TO) in liver surgery.…”

Section: Resultsmentioning

confidence: 99%

“…The TO indicators encompassed the absence of: intraoperative events ≥ grade 2 based on the Oslo classification [ 43 ]; postoperative bile leak grade B or C according to the International Study Group of Liver Surgery classification [ 44 ]; severe complications ≥ grade III according to CDC [ 20 ], in-hospital mortality, postoperative reintervention, readmission, and the presence of R0 resection margin. A recent systematic review [ 42 ] provides an overview of the contemporary international experience with TO in evaluating surgical performance after liver surgery. The review suggests that TO serves as a unified composite metric that may offer a more patient-centered approach and is better suited for quantifying optimal care and facilitating performance comparisons among centers conducting liver surgery.…”

Section: Resultsmentioning

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: Resultsmentioning

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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“…LOS was defined as the time from surgical wound closure until the patient was formally discharged from the acute hospital ward. Prolonged LOS for liver surgery was defined as a stay longer than that of the 50th percentile ( 29 ). Prolonged LOS for pancreatic surgery was defined as a stay longer than 14 days, in accordance with the definition provided by the “Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery” ( 14 ).…”

Section: Methodsmentioning

confidence: 99%

The effect of an intraoperative patient-specific, surgery-specific haemodynamic algorithm in improving textbook outcomes for hepatobiliary–pancreatic surgery: a multicentre retrospective study

Carp,

Weinberg,

Fletcher

et al. 2024

Front. Surg.

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BackgroundThe concept of a “textbook outcome” is emerging as a metric for ideal surgical outcomes. We aimed to evaluate the impact of an advanced haemodynamic monitoring (AHDM) algorithm on achieving a textbook outcome in patients undergoing hepatobiliary–pancreatic surgery.MethodsThis retrospective, multicentre observational study was conducted across private and public teaching sectors in Victoria, Australia. We studied patients managed by a patient-specific, surgery-specific haemodynamic algorithm or via usual care. The primary outcome was the effect of using a patient-specific, surgery-specific AHDM algorithm for achieving a textbook outcome, with adjustment using propensity score matching. The textbook outcome criteria were defined according to the International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery and Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery.ResultsOf the 780 weighted cases, 477 (61.2%, 95% CI: 57.7%–64.6%) achieved the textbook outcome. Patients in the AHDM group had a higher rate of textbook outcomes [n = 259 (67.8%)] than those in the Usual care group [n = 218 (54.8%); p < 0.001, estimated odds ratio (95% CI) 1.74 (1.30–2.33)]. The AHDM group had a lower rate of surgery-specific complications, severe complications, and a shorter hospital length of stay (LOS) [OR 2.34 (95% CI: 1.30–4.21), 1.79 (95% CI: 1.12–2.85), and 1.83 (95% CI: 1.35–2.46), respectively]. There was no significant difference between the groups for hospital readmission and mortality.ConclusionsAHDM use was associated with improved outcomes, supporting its integration in hepatobiliary–pancreatic surgery. Prospective trials are warranted to further evaluate the impact of this AHDM algorithm on achieving a textbook impact on long-term outcomes.

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“…There has been a recent increase in interest in the use of Textbook Outcomes (TOs) for elective surgery, including colorectal 1 , oesophagogastric 2 , bariatric 3 , hepatobiliary 4 , gynaecological 5 and cardiac 6 surgery. These TOs are composite outcome measures that seek to better describe the ‘ideal’ outcome for patients.…”

Section: Introductionmentioning

confidence: 99%

Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

Naumann,

Bhangu,

Brooks

et al. 2024

BJS Open

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Background Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy. Methods A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1–5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round. Results A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into ‘early’ and ‘longer-term’. For non-trauma patients the proposed early Textbook Outcome was ‘Discharged from hospital without serious postoperative complications (Clavien–Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was ‘Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien–Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)’. The longer-term Textbook Outcome for both non-trauma and trauma was ‘Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year’. Conclusion Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.

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Textbook Outcomes in Liver Surgery: a Systematic Review

Cited by 9 publications

References 52 publications

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

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

The effect of an intraoperative patient-specific, surgery-specific haemodynamic algorithm in improving textbook outcomes for hepatobiliary–pancreatic surgery: a multicentre retrospective study

Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

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