Arthur K E Elfrink1, Niels F M Kok2, Rutger-Jan Swijnenburg3, Marcel den Dulk4, Peter B van den Boezem5, Henk H Hartgrink6, Wouter W Te Riele7, Gijs A Patijn8, Wouter K G Leclercq9, Daan J Lips10, Ninos Ayez11, Cornelis Verhoef12, Koert F D Kuhlmann2, Carlijn I Buis13, Koop Bosscha14, Eric J T Belt15, Maarten Vermaas16, N Tjarda van Heek17, Steven J Oosterling18, Hans Torrenga19, Hasan H Eker20, Esther C J Consten21, Hendrik A Marsman22, Geert Kazemier23, Michel W J M Wouters24, Dirk J Grünhagen2, Joost M Klaase13. 1. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: elfrinkake@gmail.com. 2. Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands. 3. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 4. Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. 5. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 6. Department of Surgery, Radboud Medical Center, Nijmegen, 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 Medical Center, Breda, the Netherlands. 12. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 13. Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. 14. Department of Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands. 15. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands. 16. Department of Surgery, Ijsselland Hospital, Capelle a/d Ijssel, the Netherlands. 17. Department of Surgery, Gelderse Vallei, Ede, the Netherlands. 18. Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands. 19. Department of Surgery, Deventer Hospital, Deventer, the Netherlands. 20. Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands. 21. Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands. 22. Department of Surgery, OLVG, Amsterdam, the Netherlands. 23. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands. 24. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
Abstract
INTRODUCTION: Widespread differences in patient demographics and disease burden between hospitals for resection of colorectal liver metastases (CRLM) have been described. In the Netherlands, networks consisting of at least one tertiary referral centre and several regional hospitals have been established to optimize treatment and outcomes. The aim of this study was to assess variation in case-mix, and outcomes between these networks. METHODS: This was a population-based study including all patients who underwent CRLM resection in the Netherlands between 2014 and 2019. Variation in case-mix and outcomes between seven networks covering the whole country was evaluated. Differences in case-mix, expected 30-day major morbidity (Clavien-Dindo ≥3a) and 30-day mortality between networks were assessed. RESULTS: In total 5383 patients were included. Thirty-day major morbidity was 5.7% and 30-day mortality was 1.5%. Significant differences between networks were observed for Charlson Comorbidity Index, ASA 3+, previous liver resection, liver disease, preoperative MRI, preoperative chemotherapy, ≥3 CRLM, diameter of largest CRLM ≥55 mm, major resection, combined resection and ablation, rectal primary tumour, bilobar and extrahepatic disease. Uncorrected 30-day major morbidity ranged between 3.3% and 13.1% for hospitals, 30-day mortality ranged between 0.0% and 4.5%. Uncorrected 30-day major morbidity ranged between 4.4% and 6.0% for networks, 30-day mortality ranged between 0.0% and 2.5%. No negative outliers were observed after case-mix correction. CONCLUSION: Variation in case-mix and outcomes are considerably smaller on a network level as compared to a hospital level. Therefore, auditing is more meaningful at a network level and collaboration of hospitals within networks should be pursued.
INTRODUCTION: Widespread differences in patient demographics and disease burden between hospitals for resection of colorectal liver metastases (CRLM) have been described. In the Netherlands, networks consisting of at least one tertiary referral centre and several regional hospitals have been established to optimize treatment and outcomes. The aim of this study was to assess variation in case-mix, and outcomes between these networks. METHODS: This was a population-based study including all patients who underwent CRLM resection in the Netherlands between 2014 and 2019. Variation in case-mix and outcomes between seven networks covering the whole country was evaluated. Differences in case-mix, expected 30-day major morbidity (Clavien-Dindo ≥3a) and 30-day mortality between networks were assessed. RESULTS: In total 5383 patients were included. Thirty-day major morbidity was 5.7% and 30-day mortality was 1.5%. Significant differences between networks were observed for Charlson Comorbidity Index, ASA 3+, previous liver resection, liver disease, preoperative MRI, preoperative chemotherapy, ≥3 CRLM, diameter of largest CRLM ≥55 mm, major resection, combined resection and ablation, rectal primary tumour, bilobar and extrahepatic disease. Uncorrected 30-day major morbidity ranged between 3.3% and 13.1% for hospitals, 30-day mortality ranged between 0.0% and 4.5%. Uncorrected 30-day major morbidity ranged between 4.4% and 6.0% for networks, 30-day mortality ranged between 0.0% and 2.5%. No negative outliers were observed after case-mix correction. CONCLUSION: Variation in case-mix and outcomes are considerably smaller on a network level as compared to a hospital level. Therefore, auditing is more meaningful at a network level and collaboration of hospitals within networks should be pursued.
Authors: Shadi Katou; Franziska Schmid; Carolina Silveira; Lina Schäfer; Tizian Naim; Felix Becker; Sonia Radunz; Mazen A Juratli; Leon Louis Seifert; Hauke Heinzow; Benjamin Struecker; Andreas Pascher; M Haluk Morgul Journal: J Clin Med Date: 2022-03-29 Impact factor: 4.241