Kerollos N Wanis1, Michael Linecker2, Arin L Madenci3, Philip C Müller2, Natascha Nüssler4, Roberto Brusadin5, Ricardo Robles-Campos5, Oszkar Hahn6, Matteo Serenari7, Elio Jovine8, Nadja Lehwald9, Wolfram T Knoefel9, Tim Reese10, Karl Oldhafer10, Martin de Santibañes11, Victoria Ardiles11, Georg Lurje12, Rafaela Capelli13, Marcelo Enne13, Francesca Ratti14, Luca Aldrighetti14, Alexey S Zhurbin15, Sergey Voskanyan15, Marcel Machado16, Yuki Kitano17, René Adam17, Nikita Chardarov18, Oleg Skipenko18, Valentina Ferri19, Emilio Vicente19, Koji Tomiyama20, Roberto Hernandez-Alejandro21. 1. Department of Surgery, Western University, Ontario, Canada; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: knwanis@g.harvard.edu. 2. Department of Surgery and Transplantation, University Hospital Zurich, Switzerland. 3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 4. Department of Surgery, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany. 5. Department of Surgery and Liver and Pancreas Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain. 6. Hepato-Pancreatico-Biliary (HPB) Surgical Research Center Hungary, 1st Department of Surgery, Semmelweis University, Budapest, Hungary. 7. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 8. Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy. 9. Department of General, Visceral and Pediatric Surgery, Medical Faculty, University of Duesseldorf, University Hospital Düsseldorf, Düsseldorf, Germany. 10. Department of General, Visceral and Oncological Surgery, Asklepios Klinik Barmbek, Hamburg, Germany. 11. Department of Surgery, Hospital Italiano, Buenos Aires, Argentina. 12. Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany; Department of Surgery, Charité Universitätsmedizin Berlin, Campus Charité Mitte I Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. 13. Hepatobiliary Surgery, Ipanema Federal Hospital, Health Ministry, Rio de Janeiro, Brazil. 14. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 15. Department of Surgery, A.I. Burnazyan FMBC Russian State Scientific Center of FMBA, Moscow, Russia. 16. Department of Surgery, University of São Paulo, São Paulo, Brazil. 17. Hepato-Biliary Center, AP-HP Paul Brousse Hospital, University of Paris-Sud, Inserm U776, Villejuif, France. 18. Research Center of Surgery, Russian Academy of Medical Science, Moscow, Russia. 19. Department of General Surgery, HM Sanchinarro Hospital, Madrid, Spain. 20. Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, NY, USA. 21. Department of Surgery, Western University, Ontario, Canada; Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, NY, USA.
Abstract
BACKGROUND: Various, often conflicting, estimates for post-operative morbidity and mortality following ALPPS have been reported in the literature, suggesting that considerable center-level variation exists. Some of this variation may be related to center volume and experience. METHODS: Using data from seventeen centers who were early adopters of the ALPPS technique, we estimated the variation, by center, in standardized 90-day mortality and comprehensive complication index (CCI) for patients treated between 2012 and 2018. RESULTS: We estimated that center-specific 90-day mortality following treatment with ALPPS varied from 4.2% (95% CI: 0.8, 9.9) to 29.1% (95% CI: 13.9, 50.9), and that center-specific CCI following treatment with ALPPS varied from 17.0 (95% CI: 7.5, 26.5) to 49.8 (95% CI: 38.1, 61.8). Declines in estimated 90-day mortality and CCI were observed over time, and almost all individual centers followed this trend. Patients treated at centers with a higher number of ALPPS cases performed over the prior year had a lower risk of post-operative mortality. CONCLUSION: Despite considerable center-level variation in ALPPS outcomes, perioperative outcomes following ALPPS have improved over time and treatment at higher volume centers results in a lower risk of 90-day mortality. Morbidity and mortality remain concerningly high at some centers.
BACKGROUND: Various, often conflicting, estimates for post-operative morbidity and mortality following ALPPS have been reported in the literature, suggesting that considerable center-level variation exists. Some of this variation may be related to center volume and experience. METHODS: Using data from seventeen centers who were early adopters of the ALPPS technique, we estimated the variation, by center, in standardized 90-day mortality and comprehensive complication index (CCI) for patients treated between 2012 and 2018. RESULTS: We estimated that center-specific 90-day mortality following treatment with ALPPS varied from 4.2% (95% CI: 0.8, 9.9) to 29.1% (95% CI: 13.9, 50.9), and that center-specific CCI following treatment with ALPPS varied from 17.0 (95% CI: 7.5, 26.5) to 49.8 (95% CI: 38.1, 61.8). Declines in estimated 90-day mortality and CCI were observed over time, and almost all individual centers followed this trend. Patients treated at centers with a higher number of ALPPS cases performed over the prior year had a lower risk of post-operative mortality. CONCLUSION: Despite considerable center-level variation in ALPPS outcomes, perioperative outcomes following ALPPS have improved over time and treatment at higher volume centers results in a lower risk of 90-day mortality. Morbidity and mortality remain concerningly high at some centers.
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