Outcomes of liver surgery: A decade of mandatory nationwide auditing in the Netherlands
de Graaff, Michelle R; Klaase, Joost M; Dulk, Marcel den; Buis, C I; Derksen, Wouter J M; Hagendoorn, Jeroen; Leclercq, Wouter K G; Liem, Mike S L; Hartgrink, Henk H; Swijnenburg, Rutger-Jan; Vermaas, M; Belt, Eric J Th; Bosscha, Koop; Verhoef, Cees; Olde Damink, Steven; Kuhlmann, Koert; Marsman, H M; Ayez, Ninos; van Duijvendijk, Peter; van den Boezem, Peter; Manusama, Eric R; Grünhagen, Dirk J; Kok, Niels F M; Dutch Hepato Biliary Audit Group, Collaborators
(2024) European Journal of Surgical Oncology, volume 50, issue 6
(Article)
Abstract
Background: In 2013, the nationwide Dutch Hepato Biliary Audit (DHBA) was initiated. The aim of this study was to evaluate changes in indications for and outcomes of liver surgery in the last decade. Methods: This nationwide study included all patients who underwent liver surgery for four indications, including colorectal liver
... read more
metastases (CRLM), hepatocellular carcinoma (HCC), and intrahepatic– and perihilar cholangiocarcinoma (iCCA – pCCA) between 2014 and 2022. Trends in postoperative outcomes were evaluated separately for each indication using multilevel multivariable logistic regression analyses. Results: This study included 8057 procedures for CRLM, 838 for HCC, 290 for iCCA, and 300 for pCCA. Over time, these patients had higher risk profiles (more ASA-III patients and more comorbidities). Adjusted mortality decreased over time for CRLM, HCC and iCCA, respectively aOR 0.83, 95%CI 0.75–0.92, P < 0.001; aOR 0.86, 95%CI 0.75–0.99, P = 0.045; aOR 0.40, 95%CI 0.20–0.73, P < 0.001. Failure to rescue (FTR) also decreased for these groups, respectively aOR 0.84, 95%CI 0.76–0.93, P = 0.001; aOR 0.81, 95%CI 0.68–0.97, P = 0.024; aOR 0.29, 95%CI 0.08–0.84, P = 0.021). For iCCA severe complications (aOR 0.65 95%CI 0.43–0.99, P = 0.043) also decreased. No significant outcome differences were observed in pCCA. The number of centres performing liver resections decreased from 26 to 22 between 2014 and 2022, while median annual volumes did not change (40–49, P = 0.66). Conclusion: Over time, postoperative mortality and FTR decreased after liver surgery, despite treating higher-risk patients. The DHBA continues its focus on providing feedback and benchmark results to further enhance outcomes.
show less
Download/Full Text
Keywords: Aged, Bile Duct Neoplasms/surgery, Carcinoma, Hepatocellular/surgery, Cholangiocarcinoma/surgery, Colorectal Neoplasms/surgery, Failure to Rescue, Health Care, Female, Hepatectomy, Humans, Klatskin Tumor/surgery, Liver Neoplasms/surgery, Male, Medical Audit, Middle Aged, Netherlands/epidemiology, Postoperative Complications/epidemiology, Treatment Outcome, Quality improvement, HCC, Liver surgery, Clinical auditing, CRLM, Cholangiocarcinoma, Oncology, Surgery, Journal Article
ISSN: 0748-7983
Publisher: W.B. Saunders Ltd
Note: Publisher Copyright: © 2024 The Authors
(Peer reviewed)