Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases.

Adenocarcinoma / secondary Aged Aged, 80 and over Colorectal Neoplasms / pathology Fatty Liver / complications Female Hepatectomy Hospitals Humans Liver Cirrhosis / complications Liver Neoplasms / complications Male Metastasectomy Middle Aged Mortality Netherlands Postoperative Complications / epidemiology Quality Assurance, Health Care Reproducibility of Results Retrospective Studies Risk Adjustment Tertiary Care Centers

Journal

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

ISSN: 1532-2157

Titre abrégé: Eur J Surg Oncol

Pays: England

ID NLM: 8504356

Informations de publication

Date de publication:
03 2021

Historique:

received: 09 09 2020

revised: 07 10 2020

accepted: 12 10 2020

pubmed: 14 11 2020

medline: 15 9 2021

entrez: 13 11 2020

Statut: ppublish

Résumé

Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM). This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019. In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes. Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM.

Sections du résumé

BACKGROUND

METHODS

This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019.

RESULTS

In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes.

CONCLUSION

Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM.

Identifiants

DOI: 10.1016/j.ejso.2020.10.016 PMID: 33183927

pubmed: 33183927

pii: S0748-7983(20)30848-9

doi: 10.1016/j.ejso.2020.10.016

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

649-659

Investigateurs

Marc G H Besselink (MGH)

Marieke T de Boer (MT)

Cees H C Dejong (CHC)

Thomas M van Gulik (TM)

Jeroen Hagendoorn (J)

Frederik H J Hoogwater (FHJ)

I Quintus Molenaar (IQ)

Mike S L Liem (MSL)

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of conpeting interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.