Diamantis I Tsilimigras1, Rittal Mehta1, Katiuscha Merath1, Fabio Bagante2, Anghela Z Paredes1, Ayesha Farooq1, Francesca Ratti3, Hugo P Marques4, Silvia Silva4, Olivier Soubrane5, Vincent Lam6, George A Poultsides7, Irinel Popescu8, Razvan Grigorie8, Sorin Alexandrescu8, Guillaume Martel9, Aklile Workneh9, Alfredo Guglielmi10, Tom Hugh11, Luca Aldrighetti3, Itaru Endo12, Timothy M Pawlik13. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Surgery, University of Verona, Verona, Italy. 3. Department of Surgery, Ospedale San Raffaele, Milano, Italy. 4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France. 6. Department of Surgery, Westmead Hospital, Sydney, Australia. 7. Department of Surgery, Stanford University, Stanford, CA, USA. 8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 9. Department of Surgery, University of Ottawa, Ottawa, Canada. 10. Department of Surgery, University of Verona, Verona, Italy. 11. Department of Surgery, The University of Sydney, School of Medicine, Sydney, Australia. 12. Yokohama City University School of Medicine, Yokohama, Japan. 13. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: tim.pawlik@osumc.edu.
Abstract
BACKGROUND: Composite measures such as "Textbook Outcome" (TO) may be superior to individual quality metrics to assess surgical care and hospital performance. However, the incidence and factors associated with TO after resection of HCC remain poorly defined. METHODS: Hospital variation in the rates of TO, factors associated with achieving a TO and the impact of TO on long-term survival following resection for HCC were examined using an international multi-institutional database. RESULTS: Among 605 patients who underwent curative-intent resection of HCC, the unadjusted incidence of TO ranged from 50.9% to 77.7%. While achievement of each individual quality metric was relatively high (range, 74.5-98.0%), an overall TO was achieved among only 62.3% (n = 377) of patients. At the hospital level, TO ranged from 54.3% to 72.9%. Patients with BCLC-0 HCC (referent BCLC-B/C; OR: 4.17, 95%CI: 1.62-10.7) and ALBI grade 1 (referent ALBI grade 2/3; OR: 1.49, 95%CI: 1.06-2.11) had higher odds of achieving a TO. On multivariable analysis, TO was associated with improved overall survival (HR: 0.60, 95% CI: 0.42-0.85). CONCLUSION: Roughly 6 in 10 patients achieved a TO following resection for HCC. When achieved, TO was associated with better long-term outcomes. TO is a simple composite measure of both short- and long-term outcomes among patients undergoing resection for HCC.
BACKGROUND: Composite measures such as "Textbook Outcome" (TO) may be superior to individual quality metrics to assess surgical care and hospital performance. However, the incidence and factors associated with TO after resection of HCC remain poorly defined. METHODS: Hospital variation in the rates of TO, factors associated with achieving a TO and the impact of TO on long-term survival following resection for HCC were examined using an international multi-institutional database. RESULTS: Among 605 patients who underwent curative-intent resection of HCC, the unadjusted incidence of TO ranged from 50.9% to 77.7%. While achievement of each individual quality metric was relatively high (range, 74.5-98.0%), an overall TO was achieved among only 62.3% (n = 377) of patients. At the hospital level, TO ranged from 54.3% to 72.9%. Patients with BCLC-0 HCC (referent BCLC-B/C; OR: 4.17, 95%CI: 1.62-10.7) and ALBI grade 1 (referent ALBI grade 2/3; OR: 1.49, 95%CI: 1.06-2.11) had higher odds of achieving a TO. On multivariable analysis, TO was associated with improved overall survival (HR: 0.60, 95% CI: 0.42-0.85). CONCLUSION: Roughly 6 in 10 patients achieved a TO following resection for HCC. When achieved, TO was associated with better long-term outcomes. TO is a simple composite measure of both short- and long-term outcomes among patients undergoing resection for HCC.
Authors: Sujay Kulshrestha; Wickii T Vigneswaran; Timothy M Pawlik; Marshall S Baker; Fred A Luchette; Wissam Raad; Zaid M Abdelsattar; Richard K Freeman; Tyler Grenda; James Lubawski Journal: Semin Thorac Cardiovasc Surg Date: 2021-08-16
Authors: Daniel Azoulay; Emilio Ramos; Margarida Casellas-Robert; Chady Salloum; Laura Lladó; Roy Nadler; Juli Busquets; Celia Caula-Freixa; Kristel Mils; Santiago Lopez-Ben; Joan Figueras; Chetana Lim Journal: JHEP Rep Date: 2020-10-08