Arthur K E Elfrink1, Erik W van Zwet2, Rutger-Jan Swijnenburg3, Marcel den Dulk4, Peter B van den Boezem5, J Sven D Mieog6, Wouter W Te Riele7, Gijs A Patijn8, Wouter K G Leclercq9, Daan J Lips10, Arjen M Rijken11, Cornelis Verhoef12, Koert F D Kuhlmann13, Carlijn I Buis14, Koop Bosscha15, Eric J T Belt16, Maarten Vermaas17, N Tjarda van Heek18, Steven J Oosterling19, Hans Torrenga20, Hasan H Eker21, Esther C J Consten22, Hendrik A Marsman23, Michel W J M Wouters24, Niels F M Kok13, Dirk J Grünhagen12, Joost M Klaase14. 1. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: a.elfrink@dica.nl. 2. Department of Biomedical Data Sciences, LUMC, Leiden, the Netherlands. 3. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. 4. Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. 5. Department of Surgery, Radboud Medical Center, Nijmegen, the Netherlands. 6. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 7. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands. 8. Department of Surgery, Isala, Zwolle, the Netherlands. 9. Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands. 10. Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands. 11. Department of Surgery, Amphia Hospital, Breda, the Netherlands. 12. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 13. Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands. 14. Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. 15. Department of Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands. 16. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands. 17. Department of Surgery, Ijsselland Hospital, Capelle a/d Ijssel, the Netherlands. 18. Department of Surgery, Gelderse Vallei, Ede, the Netherlands. 19. Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands. 20. Department of Surgery, Deventer Hospital, Deventer, the Netherlands. 21. Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands. 22. Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands. 23. Department of Surgery, OLVG, Amsterdam, the Netherlands. 24. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.
Abstract
BACKGROUND: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM). METHODS: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019. RESULTS: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes. CONCLUSION: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM.
BACKGROUND: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM). METHODS: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019. RESULTS: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes. CONCLUSION: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM.
Authors: Franka S Würdemann; Arthur K E Elfrink; Janneke A Wilschut; Crispijn L van den Brand; Inger B Schipper; Johannes H Hegeman Journal: Arch Osteoporos Date: 2022-04-27 Impact factor: 2.879