TY - JOUR
T1 - Complications after liver surgery
T2 - a benchmark analysis
AU - Bagante, Fabio
AU - Ruzzenente, Andrea
AU - Beal, Eliza W.
AU - Campagnaro, Tommaso
AU - Merath, Katiuscha
AU - Conci, Simone
AU - Akgül, Ozgür
AU - Alexandrescu, Sorin
AU - Marques, Hugo P.
AU - Lam, Vincent
AU - Shen, Feng
AU - Poultsides, George A.
AU - Soubrane, Olivier
AU - Martel, Guillaume
AU - Iacono, Calogero
AU - Guglielmi, Alfredo
AU - Pawlik, Timothy M.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: The best achievable short-term outcomes after liver surgery have not been identified. Several factors may influence the post-operative course of patients undergoing hepatectomy increasing the risk of post-operative complications. We sought to identify risk-adjusted benchmark values [BMV] for liver surgery. Methods: The National Surgery Quality Improvement Program (NSQIP) database was used to develop Bayesian models to estimate risk-adjusted BMVs for overall and liver related (post-hepatectomy liver failure [PHLF], biliary leakage [BL]) complications. A separate international multi-institutional database was used to validate the risk-adjusted BMVs. Results: Among the 11,243 patients included in the NSQIP database, the incidence of complications, PHLF, and BL was 36%, 5%, and 8%, respectively. The risk-adjusted BMVs for complication (range, 16–72%), PHLF (range, 1%–20%), and BL (range, 4%–22%) demonstrated a high variability based on patients characteristics. When tested using an international database including nine institutes, the risk-adjusted BMVs for complications ranged from 26% (Institute-4) to 43% (Institute-1), BMVs for PHLF between 3% (Institute-3) and 12% (Institute-5), while BMVs for BL ranged between 5% (Institute-4) and 9% (Institute-7). Conclusions: Multiple factors influence the risk of complications following hepatectomy. Risk-adjusted BMVs are likely much more applicable and appropriate in assessing “acceptable” benchmark outcomes following liver surgery.
AB - Background: The best achievable short-term outcomes after liver surgery have not been identified. Several factors may influence the post-operative course of patients undergoing hepatectomy increasing the risk of post-operative complications. We sought to identify risk-adjusted benchmark values [BMV] for liver surgery. Methods: The National Surgery Quality Improvement Program (NSQIP) database was used to develop Bayesian models to estimate risk-adjusted BMVs for overall and liver related (post-hepatectomy liver failure [PHLF], biliary leakage [BL]) complications. A separate international multi-institutional database was used to validate the risk-adjusted BMVs. Results: Among the 11,243 patients included in the NSQIP database, the incidence of complications, PHLF, and BL was 36%, 5%, and 8%, respectively. The risk-adjusted BMVs for complication (range, 16–72%), PHLF (range, 1%–20%), and BL (range, 4%–22%) demonstrated a high variability based on patients characteristics. When tested using an international database including nine institutes, the risk-adjusted BMVs for complications ranged from 26% (Institute-4) to 43% (Institute-1), BMVs for PHLF between 3% (Institute-3) and 12% (Institute-5), while BMVs for BL ranged between 5% (Institute-4) and 9% (Institute-7). Conclusions: Multiple factors influence the risk of complications following hepatectomy. Risk-adjusted BMVs are likely much more applicable and appropriate in assessing “acceptable” benchmark outcomes following liver surgery.
UR - http://www.scopus.com/inward/record.url?scp=85060853182&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2018.12.013
DO - 10.1016/j.hpb.2018.12.013
M3 - Article
C2 - 30718185
AN - SCOPUS:85060853182
SN - 1365-182X
VL - 21
SP - 1139
EP - 1149
JO - HPB
JF - HPB
IS - 9
ER -