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An attempt to establish and apply global benchmarks for liver resection of malignant hepatic tumors.
Alaimo, Laura; Moazzam, Zorays; Lima, Henrique A; Endo, Yutaka; Ruzzenente, Andrea; Guglielmi, Alfredo; Ratti, Francesca; Aldrighetti, Luca; Weiss, Matthew; Bauer, Todd W; Alexandrescu, Sorin; Popescu, Irinel; Poultsides, George A; Maithel, Shishir K; Marques, Hugo P; Martel, Guillaume; Pulitano, Carlo; Shen, Feng; Cauchy, François; Koerkamp, Bas Groot; Endo, Itaru; Kitago, Minoru; Aucejo, Federico; Sasaki, Kazunari; Fields, Ryan C; Hugh, Tom; Lam, Vincent; Pawlik, Timothy M.
Afiliación
  • Alaimo L; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Department of Surgery, University of Verona, Italy.
  • Moazzam Z; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Lima HA; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Endo Y; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
  • Ruzzenente A; Department of Surgery, University of Verona, Italy.
  • Guglielmi A; Department of Surgery, University of Verona, Italy.
  • Ratti F; Department of Surgery, Ospedale San Raffaele, Milan, Italy.
  • Aldrighetti L; Department of Surgery, Ospedale San Raffaele, Milan, Italy.
  • Weiss M; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
  • Bauer TW; Department of Surgery, University of Virginia, Charlottesville, VA.
  • Alexandrescu S; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
  • Popescu I; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
  • Poultsides GA; Department of Surgery, Stanford University, CA.
  • Maithel SK; Department of Surgery, Emory University, Atlanta, GA.
  • Marques HP; Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
  • Martel G; Department of Surgery, University of Ottawa, ON, Canada.
  • Pulitano C; Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
  • Shen F; Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
  • Cauchy F; Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France.
  • Koerkamp BG; Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
  • Endo I; Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Japan.
  • Kitago M; Department of Surgery, Keio University, Tokyo, Japan.
  • Aucejo F; Department of General Surgery, Cleveland Clinic Foundation, OH.
  • Sasaki K; Department of Surgery, Stanford University, CA.
  • Fields RC; Department of Surgery, Washington University School of Medicine, St. Louis, MO.
  • Hugh T; Department of Surgery, School of Medicine, University of Sydney, NSW, Australia.
  • Lam V; Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
  • Pawlik TM; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. Electronic address: tim.pawlik@osumc.edu.
Surgery ; 174(6): 1384-1392, 2023 12.
Article en En | MEDLINE | ID: mdl-37741777
BACKGROUND: Benchmarking is a process of continuous self-evaluation and comparison with best-in-class hospitals to guide quality improvement initiatives. We sought to define global benchmarks relative to liver resection for malignancy and to assess their achievement in hospitals in the United States. METHODS: Patients who underwent curative-intent liver resection for hepatocellular carcinoma, intrahepatic cholangiocarcinoma, or colorectal or neuroendocrine liver metastases between 2000 and 2019 were identified from an international multi-institutional database. Propensity score matching was conducted to balance baseline characteristics between open and minimally invasive approaches. Best-in-class hospitals were defined relative to the achievement rate of textbook oncologic outcomes and case volume. Benchmark values were established relative to best-in-class institutions. The achievement of benchmark values among hospitals in the National Cancer Database was then assessed. RESULTS: Among 2,624 patients treated at 20 centers, a majority underwent liver resection for hepatocellular carcinoma (n = 1,609, 61.3%), followed by colorectal liver metastases (n = 650, 24.8%), intrahepatic cholangiocarcinoma (n = 299, 11.4%), and neuroendocrine liver metastases (n = 66, 2.5%). Notably, 1,947 (74.2%) patients achieved a textbook oncologic outcome. After propensity score matching, 6 best-in-class hospitals with the highest textbook oncologic outcome rates (≥75.0%) were identified. Benchmark values were calculated for margin positivity (≤11.7%), 30-day readmission (≤4.1%), 30-day mortality (≤1.6%), minor postoperative complications (≤24.7%), severe complications (≤12.4%), and failure to achieve the textbook oncologic outcome (≤22.8%). Among the National Cancer Database hospitals, global benchmarks for margin positivity, 30-day readmission, 30-day mortality, severe complications, and textbook oncologic outcome failure were achieved in 62.9%, 27.1%, 12.1%, 7.1%, and 29.3% of centers, respectively. CONCLUSION: These global benchmarks may help identify hospitals that may benefit from quality improvement initiatives, aiming to improve patient safety and surgical oncologic outcomes.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de los Conductos Biliares / Neoplasias Colorrectales / Colangiocarcinoma / Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Surgery Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias de los Conductos Biliares / Neoplasias Colorrectales / Colangiocarcinoma / Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Surgery Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos