Complications after liver surgery: a benchmark analysis

Fabio Bagante, Andrea Ruzzenente, Eliza W. Beal, Tommaso Campagnaro, Katiuscha Merath, Simone Conci, Ozgür Akgül, Sorin Alexandrescu, Hugo P. Marques, Vincent Lam, Feng Shen, George A. Poultsides, Olivier Soubrane, Guillaume Martel, Calogero Iacono, Alfredo Guglielmi, Timothy M. Pawlik

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

LanguageEnglish
JournalHPB
DOIs
Publication statusAccepted/In press - 2019
Externally publishedYes

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Benchmarking
Hepatectomy
Liver Failure
Liver
Databases
Quality Improvement
Incidence

Cite this

Bagante, F., Ruzzenente, A., Beal, E. W., Campagnaro, T., Merath, K., Conci, S., ... Pawlik, T. M. (Accepted/In press). Complications after liver surgery: a benchmark analysis. HPB. https://doi.org/10.1016/j.hpb.2018.12.013
Bagante, Fabio ; Ruzzenente, Andrea ; Beal, Eliza W. ; Campagnaro, Tommaso ; Merath, Katiuscha ; Conci, Simone ; Akgül, Ozgür ; Alexandrescu, Sorin ; Marques, Hugo P. ; Lam, Vincent ; Shen, Feng ; Poultsides, George A. ; Soubrane, Olivier ; Martel, Guillaume ; Iacono, Calogero ; Guglielmi, Alfredo ; Pawlik, Timothy M. / Complications after liver surgery : a benchmark analysis. In: HPB. 2019.
@article{287994d82a614e3abd9be09ef121c05c,
title = "Complications after liver surgery: a benchmark analysis",
abstract = "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.",
author = "Fabio Bagante and Andrea Ruzzenente and Beal, {Eliza W.} and Tommaso Campagnaro and Katiuscha Merath and Simone Conci and Ozg{\"u}r Akg{\"u}l and Sorin Alexandrescu and Marques, {Hugo P.} and Vincent Lam and Feng Shen and Poultsides, {George A.} and Olivier Soubrane and Guillaume Martel and Calogero Iacono and Alfredo Guglielmi and Pawlik, {Timothy M.}",
year = "2019",
doi = "10.1016/j.hpb.2018.12.013",
language = "English",
journal = "HPB",
issn = "1365-182X",
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Bagante, F, Ruzzenente, A, Beal, EW, Campagnaro, T, Merath, K, Conci, S, Akgül, O, Alexandrescu, S, Marques, HP, Lam, V, Shen, F, Poultsides, GA, Soubrane, O, Martel, G, Iacono, C, Guglielmi, A & Pawlik, TM 2019, 'Complications after liver surgery: a benchmark analysis' HPB. https://doi.org/10.1016/j.hpb.2018.12.013

Complications after liver surgery : a benchmark analysis. / Bagante, Fabio; Ruzzenente, Andrea; Beal, Eliza W.; Campagnaro, Tommaso; Merath, Katiuscha; Conci, Simone; Akgül, Ozgür; Alexandrescu, Sorin; Marques, Hugo P.; Lam, Vincent; Shen, Feng; Poultsides, George A.; Soubrane, Olivier; Martel, Guillaume; Iacono, Calogero; Guglielmi, Alfredo; Pawlik, Timothy M.

In: HPB, 2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Complications after liver surgery

T2 - HPB

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

Y1 - 2019

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

JO - HPB

JF - HPB

SN - 1365-182X

ER -

Bagante F, Ruzzenente A, Beal EW, Campagnaro T, Merath K, Conci S et al. Complications after liver surgery: a benchmark analysis. HPB. 2019. https://doi.org/10.1016/j.hpb.2018.12.013