Benchmark performance of laparoscopic left lateral sectionectomy and right hepatectomy in expert centers.
Benchmarking
/ methods
Blood Transfusion
/ statistics & numerical data
Female
France
/ epidemiology
Health Care Surveys
Hepatectomy
/ adverse effects
Hospitals
/ classification
Humans
Laparoscopy
/ adverse effects
Length of Stay
/ statistics & numerical data
Liver Neoplasms
/ pathology
Male
Margins of Excision
Mortality
Outcome and Process Assessment, Health Care
/ methods
Patient Readmission
/ statistics & numerical data
Postoperative Complications
/ epidemiology
Quality Indicators, Health Care
/ standards
Benchmark
Laparoscopic liver resection
Left lateral sectionectomy
Quality of care
Right hepatectomy
Textbook outcome
Journal
Journal of hepatology
ISSN: 1600-0641
Titre abrégé: J Hepatol
Pays: Netherlands
ID NLM: 8503886
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
24
02
2020
revised:
01
05
2020
accepted:
05
05
2020
pubmed:
15
5
2020
medline:
16
11
2021
entrez:
15
5
2020
Statut:
ppublish
Résumé
Herein, we aimed to establish benchmark values - based on a composite indicator of healthcare quality - for the performance of laparoscopic left lateral sectionectomy (LLLS) and laparoscopic right hepatectomy (LRH) using data from expert centers. Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all 6 of the following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off laparoscopic liver resection (LLR) volume by center was associated with TO on multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers. Among 4,400 LLRs performed in 29 centers, 855 patients who underwent LLLS and 488 who underwent LRH were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (odds ratio [OR] 2.45; bootstrap 95% CI 1.65-3.69; p = 0.001) and 35 LLR/year (OR 2.55; bootstrap 95% CI 1.34-5.63; p = 0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers for LLLS and 6 centers for LRH, including 516 and 346 patients undergoing LLLS/LRH respectively, reached these cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%, respectively. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%, respectively. This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers. In a nationwide French survey of laparoscopic liver resection, expert centers were defined according to the completion of a textbook outcome, which is a composite indicator of healthcare quality. Benchmark values regarding intra-operative details and outcomes were established using data from 516 patients with laparoscopic left lateral sectionectiomy and 346 patients with laparoscopic right hepatectomy from expert centers. These values should be used as a reference point to improve the quality of laparoscopic resections.
Sections du résumé
BACKGROUND & AIMS
Herein, we aimed to establish benchmark values - based on a composite indicator of healthcare quality - for the performance of laparoscopic left lateral sectionectomy (LLLS) and laparoscopic right hepatectomy (LRH) using data from expert centers.
METHODS
Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all 6 of the following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off laparoscopic liver resection (LLR) volume by center was associated with TO on multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers.
RESULTS
Among 4,400 LLRs performed in 29 centers, 855 patients who underwent LLLS and 488 who underwent LRH were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (odds ratio [OR] 2.45; bootstrap 95% CI 1.65-3.69; p = 0.001) and 35 LLR/year (OR 2.55; bootstrap 95% CI 1.34-5.63; p = 0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers for LLLS and 6 centers for LRH, including 516 and 346 patients undergoing LLLS/LRH respectively, reached these cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%, respectively. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%, respectively.
CONCLUSIONS
This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers.
LAY SUMMARY
In a nationwide French survey of laparoscopic liver resection, expert centers were defined according to the completion of a textbook outcome, which is a composite indicator of healthcare quality. Benchmark values regarding intra-operative details and outcomes were established using data from 516 patients with laparoscopic left lateral sectionectiomy and 346 patients with laparoscopic right hepatectomy from expert centers. These values should be used as a reference point to improve the quality of laparoscopic resections.
Identifiants
pubmed: 32407812
pii: S0168-8278(20)30295-6
doi: 10.1016/j.jhep.2020.05.003
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1100-1108Investigateurs
T Nomi
(T)
N Oudafal
(N)
T Kawai
(T)
S Komatsu
(S)
S Okumura
(S)
N Petrucciani
(N)
A Laurent
(A)
P Bucur
(P)
L Barbier
(L)
B Trechot
(B)
J Nunèz
(J)
M Tedeschi
(M)
M-A Allard
(MA)
N Golse
(N)
O Ciacio
(O)
G Pittau
(G)
A Sa Cunha
(A)
R Adam
(R)
C Laurent
(C)
L Chiche
(L)
P Leourier
(P)
L Rebibo
(L)
J-M Regimbeau
(JM)
L Ferre
(L)
F R Souche
(FR)
J Chauvat
(J)
J-M Fabre
(JM)
F Jehaes
(F)
K Mohkam
(K)
M Lesurtel
(M)
C Ducerf
(C)
J-Y Mabrut
(JY)
T Hor
(T)
F Paye
(F)
P Balladur
(P)
B Suc
(B)
F Muscari
(F)
G Millet
(G)
M El Amrani
(M)
C Ratajczak
(C)
K Lecolle
(K)
E Boleslawski
(E)
S Truant
(S)
F-R Pruvot
(FR)
A-R Kianmanesh
(AR)
T Codjia
(T)
L Schwarz
(L)
E Girard
(E)
J Abba
(J)
C Letoublon
(C)
M Chirica
(M)
A Carmelo
(A)
C VanBrugghe
(C)
Z Cherkaoui
(Z)
X Unterteiner
(X)
R Memeo
(R)
P Pessaux
(P)
E Buc
(E)
E Lermite
(E)
J Barbieux
(J)
M Bougard
(M)
U Marchese
(U)
J Ewald
(J)
O Turini
(O)
A Thobie
(A)
B Menahem
(B)
A Mulliri
(A)
J Lubrano
(J)
J Zemour
(J)
H Fagot
(H)
G Passot
(G)
E Gregoire
(E)
J Hardwigsen
(J)
Y-P le Treut
(YP)
D Patrice
(D)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details.