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Gundavda KK, Patkar S, Kannan S, Varty GP, Nandy K, Shah T, Polusany K, Solanki SL, Kulkarni S, Shetty N, Gala K, Ostwal V, Ramaswamy A, Bhargava P, Goel M. Realizing Textbook Outcomes Following Liver Resection for Hepatic Neoplasms with Development and Validation of a Predictive Nomogram. Ann Surg Oncol 2024:10.1245/s10434-024-15983-6. [PMID: 39103690 DOI: 10.1245/s10434-024-15983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND 'Textbook Outcome' (TO) represents an effort to define a standardized, composite quality benchmark based on intraoperative and postoperative endpoints. This study aimed to assess the applicability of TO as an outcome measure following liver resection for hepatic neoplasms from a low- to middle-income economy and determine its impact on long-term survival. Based on identified perioperative predictors, we developed and validated a nomogram-based scoring and risk stratification system. METHODS We retrospectively analyzed patients undergoing curative resections for hepatic neoplasms between 2012 and 2023. Rates of TO were assessed over time and factors associated with achieving a TO were evaluated. Using stepwise regression, a prediction nomogram for achieving TO was established based on perioperative risk factors. RESULTS Of the 1018 consecutive patients who underwent liver resections, a TO was achieved in 64.9% (661/1018). The factor most responsible for not achieving TO was significant post-hepatectomy liver failure (22%). Realization of TO was independently associated with improved overall and disease-free survival. On logistic regression, American Society of Anesthesiologists score of 2 (p = 0.0002), perihilar cholangiocarcinoma (p = 0.011), major hepatectomy (p = 0.0006), blood loss >1500 mL (p = 0.007), and presence of lymphovascular emboli on pathology (p = 0.026) were associated with the non-realization of TO. These independent risk factors were integrated into a nomogram prediction model with the predictive efficiency for TO (area under the curve 75.21%, 95% confidence interval 70.69-79.72%). CONCLUSION TO is a realizable outcome measure and should be adopted. We recommend the use of the nomogram proposed as a convenient tool for patient selection and prognosticating outcomes following hepatectomy.
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Affiliation(s)
- Kaival K Gundavda
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shraddha Patkar
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Department of Biostatistics, The Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gurudutt P Varty
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Kunal Nandy
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Tanvi Shah
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Kaushik Polusany
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sohan Lal Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Intervention Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Nitin Shetty
- Department of Intervention Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Intervention Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
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Xu Z, Lv Y, Zou H, Jia Y, Du W, Lu J, Liu Y, Shao Z, Zhang H, Sun C, Zhu C. Textbook outcome of laparoscopic hepatectomy in the context of precision surgery: A single center experience. Dig Liver Dis 2024; 56:1368-1374. [PMID: 38724344 DOI: 10.1016/j.dld.2024.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 07/29/2024]
Abstract
OBJECTIVE Laparoscopic hepatectomy (LH) has become a common surgery for the treatment of liver tumor. To evaluate the surgical quality of laparoscopic hepatectomy under the context of precision surgery with Textbook outcome (TO), a comprehensive and holistic assessment approach. METHODS A total of 1056 patients who underwent laparoscopic hepatectomy from May 2016 and December 2022 were enrolled in the study. All the patients were performed hepatectomy. The rate of TO and factors associated with achieving TO were examined. RESULTS Among the 1056 patients, 75 % patients achieved TO. The main reason limited patients achieving textbook outcomes was prolonged length of hospital stay (LOS). The univariate analysis indicated that age>65, ASA classification ≥3, liver cirrhosis, tumor size > 3 cm, tumor number ≥2, type of primary cancer, and IWATE DSS were significantly associated with non-achievement of TO. The multivariate analysis indicated that the ASA classification ≥3 and advanced difficulty level in IWATE DSS independent factors associated with achieving TO. Reaching TO can significantly prolong the postoperative recurrence time and overall survival time of hepatocellular carcinoma patients. CONCLUSION In the context of precision surgery, 75 % patients undergoing laparoscopic hepatectomy achieved a TO. Patients who achieved TO had significantly improved survival.
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Affiliation(s)
- Zejiang Xu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Yaqing Lv
- Department of Wound Care Clinic, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Hao Zou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Yuanfang Jia
- Department of Anesthesia, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Wenhao Du
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Jinbin Lu
- Department of General Surgery, Laixi City People's Hospital, No.16 Yantai Road, Laixi, Qingdao, PR China
| | - Yang Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Zemin Shao
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Hao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China
| | - Chuandong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China.
| | - Chengzhan Zhu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, PR China; Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, PR China.
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Nicolazzi M, Di Martino M, Baroffio P, Donadon M. 6,126 hepatectomies in 2022: current trend of outcome in Italy. Langenbecks Arch Surg 2024; 409:211. [PMID: 38985363 PMCID: PMC11236879 DOI: 10.1007/s00423-024-03398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024]
Abstract
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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Affiliation(s)
- Marco Nicolazzi
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Paolo Baroffio
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy.
- Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy.
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Rashid Z, Munir MM, Woldesenbet S, Khalil M, Katayama E, Khan MMM, Endo Y, Altaf A, Tsai S, Dillhoff M, Pawlik TM. Association of preoperative cholangitis with outcomes and expenditures among patients undergoing pancreaticoduodenectomy. J Gastrointest Surg 2024; 28:1137-1144. [PMID: 38762337 DOI: 10.1016/j.gassur.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/20/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND This study aimed to characterize the association of preoperative acute cholangitis (PAC) with surgical outcomes and healthcare costs. METHODS Patients who underwent pancreaticoduodenectomy (PD) between 2013 and 2021 were identified using 100% Medicare Standard Analytic Files. PAC was defined as the occurrence of at least 1 episode of acute cholangitis within the year preceding surgery. Multivariable regression analyses were used to compare postoperative outcomes and costs relative to PAC. RESULTS Among 23,455 Medicare beneficiaries who underwent PD, 2,217 patients (9.5%) had at least 1 episode of PAC. Most patients (n = 14,729 [62.8%]) underwent PD for a malignant indication. On multivariable analyses, PAC was associated with elevated odds of surgical site infection (odds ratio [OR], 1.14; 95% CI, 1.01-1.29), sepsis (OR, 1.17; 95% CI, 1.01-1.37), extended length of stay (OR, 1.13; 95% CI, 1.01-1.26), and readmission within 90 days (OR, 1.14; 95% CI, 1.04-1.26). Patients with a history of PAC before PD had a reduced likelihood of achieving a postoperative textbook outcome (OR, 0.83; 95% CI, 0.75-0.92) along with 87.8% and 18.4% higher associated preoperative and postoperative healthcare costs, respectively (all P < .001). Overall costs increased substantially among patients with more than 1 PAC episode ($59,893 [95% CI, $57,827-$61,959] for no episode vs $77,922 [95% CI, $73,854-$81,990] for 1 episode vs $101,205 [95% CI, $94,871-$107,539] for multiple episodes). CONCLUSION Approximately 1 in 10 patients undergoing PD experienced an antecedent PAC episode, which was associated with adverse surgical outcomes and greater healthcare expenditures.
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Affiliation(s)
- Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Muntazir Mehdi Khan
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Susan Tsai
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
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Carp B, Weinberg L, Fletcher LR, Hinton JV, Cohen A, Slifirski H, Le P, Woodford S, Tosif S, Liu D, Muralidharan V, Perini MV, Nikfarjam M, Lee DK. The effect of an intraoperative patient-specific, surgery-specific haemodynamic algorithm in improving textbook outcomes for hepatobiliary-pancreatic surgery: a multicentre retrospective study. Front Surg 2024; 11:1353143. [PMID: 38859998 PMCID: PMC11163073 DOI: 10.3389/fsurg.2024.1353143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/06/2024] [Indexed: 06/12/2024] Open
Abstract
Background The 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. Methods This 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. Results Of 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. Conclusions AHDM 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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Affiliation(s)
- Bradly Carp
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Luke R. Fletcher
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
- Data Analytical Research Unit, Austin Health, Melbourne, VIC, Australia
| | - Jake V. Hinton
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Adam Cohen
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Hugh Slifirski
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Le
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Woodford
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shervin Tosif
- Department of Anaesthesia, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - David Liu
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Marcos V. Perini
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Lopez-Lopez V, Kuemmerli C, Maupoey J, López-Andujar R, Lladó L, Mils K, Müller P, Valdivieso A, Garcés-Albir M, Sabater L, Cacciaguerra AB, Vivarelli M, Valladares LD, Pérez SA, Flores B, Brusadin R, Conesa AL, Cortijo SM, Paterna S, Serrablo A, Toop FHW, Oldhafer K, Sánchez-Cabús S, Gil AG, Masía JAG, Loinaz C, Lucena JL, Pastor P, Garcia-Zamora C, Calero A, Valiente J, Minguillon A, Rotellar F, Alcazar C, Aguilo J, Cutillas J, Ruiperez-Valiente JA, Ramírez P, Petrowsky H, Ramia JM, Robles-Campos R. Textbook outcome in patients with biliary duct injury during cholecystectomy. J Gastrointest Surg 2024; 28:725-730. [PMID: 38480039 DOI: 10.1016/j.gassur.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Iatrogenic bile duct injury (BDI) during cholecystectomy is associated with a complex and heterogeneous management owing to the burden of morbidity until their definitive treatment. This study aimed to define the textbook outcomes (TOs) after BDI with the purpose to indicate the ideal treatment and to improve it management. METHODS We collected data from patients with an BDI between 1990 and 2022 from 27 hospitals. TO was defined as a successful conservative treatment of the iatrogenic BDI or only minor complications after BDI or patients in whom the first repair resolves the iatrogenic BDI without complications or with minor complications. RESULTS We included 808 patients and a total of 394 patients (46.9%) achieved TO. Overall complications in TO and non-TO groups were 11.9% and 86%, respectively (P < .001). Major complications and mortality in the non-TO group were 57.4% and 9.2%, respectively. The use of end-to-end bile duct anastomosis repair was higher in the non-TO group (23.1 vs 7.8, P < .001). Factors associated with achieving a TO were injury in a specialized center (adjusted odds ratio [aOR], 4.01; 95% CI, 2.68-5.99; P < .001), transfer for a first repair (aOR, 5.72; 95% CI, 3.51-9.34; P < .001), conservative management (aOR, 5.00; 95% CI, 1.63-15.36; P = .005), or surgical management (aOR, 2.45; 95% CI, 1.50-4.00; P < .001). CONCLUSION TO largely depends on where the BDI is managed and the type of injury. It allows hepatobiliary centers to identify domains of improvement of perioperative management of patients with BDI.
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Affiliation(s)
- Victor Lopez-Lopez
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain.
| | - Christoph Kuemmerli
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Javier Maupoey
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Rafael López-Andujar
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Laura Lladó
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Kristel Mils
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Philip Müller
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland; Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andres Valdivieso
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Andrea Benedetti Cacciaguerra
- Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Marco Vivarelli
- Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Luis Díez Valladares
- Department of Surgery, Hepatopancreatobiliary Unit, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Benito Flores
- Department of Surgery, Morales University Hospital, Madrid, Spain
| | - Roberto Brusadin
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
| | - Asunción López Conesa
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
| | | | - Sandra Paterna
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alejando Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Karl Oldhafer
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asklepios Hospital Barmbek, Germany
| | - Santiago Sánchez-Cabús
- Hepatobiliopancreatic Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio González Gil
- Department of Surgery, Los Arcos del Mar Menor University Hospital, Murcia, Spain
| | | | - Carmelo Loinaz
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Jose Luis Lucena
- Department of Surgery, Puerta del Hierro University Hospital, Madrid, Spain
| | - Patricia Pastor
- Department of Surgery, Reina Sofía University Hospital, Murcia, Spain
| | | | - Alicia Calero
- Department of General Surgery, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Juan Valiente
- Department of General Surgery, Hellin Hospital, Albacete, Spain
| | | | - Fernando Rotellar
- Institute of Health Research of Navarra (IDISNA), Pamplona, Spain; HPB and Liver Transplant Unit, Abdominal and General Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Cándido Alcazar
- Department of Surgery, University Hospital of Alicante, and Universidad Miguel Hernandez, ISABIAL, Alicante, Spain
| | - Javier Aguilo
- Department of General Surgery, Hospital Lluís Alcanyís Hospital, Xàtiva, Valencia, Spain
| | - Jose Cutillas
- Department of General Surgery, Hospital Francesc de Borja, Gandía, Valencia, Spain
| | | | - Pablo Ramírez
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jose Manuel Ramia
- Department of Surgery, University Hospital of Alicante, and Universidad Miguel Hernandez, ISABIAL, Alicante, Spain
| | - Ricardo Robles-Campos
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
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Serenari M, Ratti F, Stocco A, De Cobelli F, Serra C, Santangelo D, Fallani G, Della Corte A, Marino R, Ravaioli M, Aldrighetti L, Cescon M. Achievement of textbook outcome after hepatectomy combined with thermal ablation for colorectal liver metastases. Surg Endosc 2024; 38:2611-2621. [PMID: 38499784 DOI: 10.1007/s00464-024-10757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Hepatic resection combined with intraoperative ablation has been described as a technical solution potentially widening the resectability rate of patients with colorectal liver metastases (CRLM). Nevertheless, the perioperative and oncological benefit provided by this combined approach remains unclear. We hypothesized that textbook outcome (TO), which is a composite measure achieved for patients for whom some desired health indicators are met, may help to refine the indications of this approach. METHODS Patients submitted to hepatectomy with curative intent in combination with radiofrequency ablation or microwave ablation for CRLM ≤ 3 cm in two tertiary referral centers were included. TO was defined according to a recent definition for liver surgery based on a Delphi process including also the achievement of complete radiological response of the ablated lesion/s at 4 weeks. RESULTS Between 2015 and 2022, 112 patients were enrolled. Among them, 63 (56.2%) achieved a TO. According to multivariate analysis, minimally invasive (MI) approach (OR 2.72, 95% CI 0.99-7.48, p = 0.050), simultaneous CR resection (OR 0.28, 95% CI 0.11-0.70, p = 0.007), tumor burden score (OR 0.89, 95% CI 0.82-0.96, p = 0.004), and major hepatectomy (OR 0.12, 95% CI 0.03-0.52, p = 0.004) were significantly associated with the achievement of TO. Median overall survival was longer in those patients who were able to achieve a TO compared to those who did not. CONCLUSIONS The combination of hepatectomy and ablation constitutes a valuable solution in patients affected by multiple CRLM and it may provide, also using a MI approach, adequate perioperative and oncological outcomes, allowing to achieve TO, however, in a selected number of patients and depending on several factors including the burden of disease.
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Affiliation(s)
- Matteo Serenari
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Stocco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Surgical and Medical Sciences, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Domenico Santangelo
- Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Guido Fallani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Ravaioli
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Cescon
- Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Naumann DN, Bhangu A, Brooks A, Martin M, Cotton BA, Khan M, Midwinter MJ, Pearce L, Bowley DM, Holcomb JB, Griffiths EA. Novel Textbook Outcomes following emergency laparotomy: Delphi exercise. BJS Open 2024; 8:zrad145. [PMID: 38284399 PMCID: PMC10823418 DOI: 10.1093/bjsopen/zrad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/03/2023] [Indexed: 01/30/2024] Open
Abstract
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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Affiliation(s)
- David N Naumann
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aneel Bhangu
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Global Health Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham, UK
| | - Matthew Martin
- Division of Trauma and Acute Care Surgery, Department of Surgery, Los Angeles County & USC Medical Center, Los Angeles, California, USA
| | - Bryan A Cotton
- The Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mansoor Khan
- Department of General Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Mark J Midwinter
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Lyndsay Pearce
- Department of General Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Douglas M Bowley
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John B Holcomb
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ewen A Griffiths
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Mclauchlan J, de Burlet K, Nonis M, Hore T, Connor S. Textbook outcomes for liver resection: can a medium sized centre have acceptable outcomes? ANZ J Surg 2023; 93:2892-2896. [PMID: 37784257 DOI: 10.1111/ans.18724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 08/01/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Textbook outcome (TO) is an objective, composite measure of clinical outcomes in surgery. TO in liver surgery has been used in previous international studies to define and compare performance across centres. This study aimed to review TO rates following liver resection at a single institution. The secondary aim was to use a CuSum analysis to evaluate monitoring of performance quality over time for colorectal cancer liver metastases (CRCLM). METHODS All patients undergoing liver resection for benign and malignant causes from Christchurch Hospital hepatobiliary unit between 2005 and 2022 were included. Textbook outcomes measures were the absence of; intraoperative incidents, Clavien-Dindo >3 complication, 90 day re-admission, 90 day mortality, R1 resection, and post-operative bile leak/liver failure. Sequential CuSum analysis was performed to review achievement of TO in liver resections for colorectal cancer liver metastases (CRCLM). RESULTS Four hundred and seventy-eight patients were included in this study, 54 had resection for benign pathology, 290 for CRCLM and 134 for other malignancies. TO was achieved in 74% of cases overall, with rates for benign, CRCLM and other malignancy being 82%, 73% and 74% respectively (P = 0.405). CuSum analysis documented a deterioration in performance after patient 60, with return to baseline by end of study period. CONCLUSIONS TO for liver resection in a medium sized centre in New Zealand are comparable to published rates. It is possible to use process control techniques like CuSum with the binary result of TO to monitor performance, providing opportunity for continuous improvement in surgical units.
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Affiliation(s)
- Jared Mclauchlan
- Department of General Surgery, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Kirsten de Burlet
- Department of General Surgery, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Maria Nonis
- Department of General Surgery, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Todd Hore
- Department of General Surgery, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Saxon Connor
- Department of General Surgery, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
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