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Multicenter Study
. 2022 May;29(5):521-530.
doi: 10.1002/jhbp.1141. Epub 2022 Apr 5.

Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections

Alessandro Cucchetti  1   2 , Luca Aldrighetti  3 , Francesca Ratti  3 , Alessandro Ferrero  4 , Alfredo Guglielmi  5 , Felice Giuliante  6 , Umberto Cillo  7 , Vincenzo Mazzaferro  8 , Luciano De Carlis  9 , Giorgio Ercolani  1   2 ; I Go MILS Group
Collaborators, Affiliations
Multicenter Study

Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections

Alessandro Cucchetti et al. J Hepatobiliary Pancreat Sci. 2022 May.

Abstract

Background/purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. The purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR).

Methods: Data from a prospective, multicenter database involving 4318 patients submitted to LLRs in 41 hospitals from an intention-to-treat approach (2014-2020) were used to analyze heterogeneity (I2 ) among centers and to develop a risk-adjustment model on outcome measures through multivariable mixed-effect models to account for confounding due to case-mix.

Results: Involved hospitals operated on very different patients: the largest heterogeneity was observed for operating in the presence of previous abdominal surgery (I2 :79.1%), in cirrhotic patients (I2 :89.3%) suffering from hepatocellular carcinoma (I2 :88.6%) or requiring associated intestinal resections (I2 :82.8%) and in regard to technical complexity (I2 for the most complex LLRs: 84.1%). These aspects determined substantial or large heterogeneity in overall morbidity (I2 :84.9%), in prolonged in-hospital stay (I2 :86.9%) and in conversion rate (I2 :73.4%). Major complication had medium heterogeneity (I2 :46.5%). The heterogeneity of mortality was null. Risk-adjustment accounted for all of this variability and the final risk-standardized conversion rate was 8.9%, overall morbidity was 22.1%, major morbidity was 5.1% and prolonged in-hospital stay was 26.0%. There were no outliers among the 41 participating centers. An online tool was provided.

Conclusions: A benchmark for LLRs including all eligible patients was provided, suggesting that surgeons can act accordingly in the interest of the patient, modifying their approach in relation to different indications and different experience, but finally providing the same quality of care.

Keywords: heterogeneity; laparoscopic liver resection; mortality, morbidity; risk-adjustment.

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Conflict of interest statement

None to declare.

Figures

FIGURE 1
FIGURE 1
Risk‐standardized conversion rate, overall morbidity, major morbidity and prolonged in‐hospital stay prevalence. Noticeably, all participating centers fall within 95% confidence intervals, supporting that despite different patients and interventions, all surgeons can accordingly act to produce similar safety outcomes
FIGURE 2
FIGURE 2
Exemplification of how the risk standardization model works, and how an additional center can compare its performance against that of the I go MILS. An excel spreadsheet for calculation is provided as Data S1 and Data S2.
See this image and copyright information in PMC

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