TY - JOUR
T1 - Analysis of a modified surgical desirability of outcome ranking (mDOOR) among patients undergoing surgery for Hepatocellular carcinoma
AU - Catalano, Giovanni
AU - Alaimo, Laura
AU - Chatzipanagiotou, Odysseas P.
AU - Ruzzenente, Andrea
AU - Aucejo, Federico
AU - Marques, Hugo P.
AU - Lam, Vincent
AU - Hugh, Tom
AU - Bhimani, Nazim
AU - Kitago, Minoru
AU - Endo, Itaru
AU - Martel, Guillaume
AU - Popescu, Irinel
AU - Cauchy, François
AU - Poultsides, George A.
AU - Gleisner, Ana
AU - Pawlik, Timothy M.
PY - 2025/6
Y1 - 2025/6
N2 - Background: Composite measures represent a validated method for evaluating surgical care quality. We defined a modified Desirability Of Outcome Ranking (mDOOR) and compared it with textbook outcome (TO). Methods: In this cohort study, patients undergoing curative-intent surgery for HCC were identified from an international cohort. The performance and agreement of mDOOR, TO, and other measures of postoperative course with respect to overall survival (OS) were compared using Harrell's Concordance-index (C-index) and Cohen's kappa. Results: Among 2181 patients, 77.6 % (n = 1692) achieved the most desirable outcome (i.e., DOOR1), whereas roughly one-half of patients achieved TO (n = 1,171, 53.7 %). Patients with lower mDOOR had a better 5-year OS compared with patients with higher mDOOR (64.7 % vs. 51.9 %; p < 0.001). On multivariable analysis, higher mDOOR was associated with worse OS (HR 1.35, 95%CI 1.28–1.44; p < 0.001). The mDOOR demonstrated improved performance compared with the comprehensive complication index (C-index: 0.696 vs. 0.649; p < 0.001) and the Accordion score (C-index: 0.696 vs. 0.653; p = 0.002). Conclusion: Roughly 4 out of 5 patients achieved the most desirable outcome. Higher mDOOR was associated with worse long-term outcomes. A composite outcome ranking may provide more insight on surgical outcomes, complementing traditional metrics.
AB - Background: Composite measures represent a validated method for evaluating surgical care quality. We defined a modified Desirability Of Outcome Ranking (mDOOR) and compared it with textbook outcome (TO). Methods: In this cohort study, patients undergoing curative-intent surgery for HCC were identified from an international cohort. The performance and agreement of mDOOR, TO, and other measures of postoperative course with respect to overall survival (OS) were compared using Harrell's Concordance-index (C-index) and Cohen's kappa. Results: Among 2181 patients, 77.6 % (n = 1692) achieved the most desirable outcome (i.e., DOOR1), whereas roughly one-half of patients achieved TO (n = 1,171, 53.7 %). Patients with lower mDOOR had a better 5-year OS compared with patients with higher mDOOR (64.7 % vs. 51.9 %; p < 0.001). On multivariable analysis, higher mDOOR was associated with worse OS (HR 1.35, 95%CI 1.28–1.44; p < 0.001). The mDOOR demonstrated improved performance compared with the comprehensive complication index (C-index: 0.696 vs. 0.649; p < 0.001) and the Accordion score (C-index: 0.696 vs. 0.653; p = 0.002). Conclusion: Roughly 4 out of 5 patients achieved the most desirable outcome. Higher mDOOR was associated with worse long-term outcomes. A composite outcome ranking may provide more insight on surgical outcomes, complementing traditional metrics.
UR - http://www.scopus.com/inward/record.url?scp=86000735050&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2025.02.013
DO - 10.1016/j.hpb.2025.02.013
M3 - Article
C2 - 40090779
AN - SCOPUS:86000735050
SN - 1365-182X
VL - 27
SP - 799
EP - 806
JO - HPB
JF - HPB
IS - 6
ER -