Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation - Sorbonne Université, CRCA Saint Antoine, Hôpital Pitié Salpétrière, 47 boulevard de l'hôpital, 75013, Paris, France.
Department of Digestive, Oncologic and Metabolic Surgery - Institut Mutualiste Montsouris, University Paris Descartes, 42 Boulevard Jourdan, 75014 Paris, France.
J Hepatol. 2020 Nov;73(5):1100-1108. doi: 10.1016/j.jhep.2020.05.003. Epub 2020 May 11.
BACKGROUND & AIMS: Herein, we aimed to establish benchmark values - based on a composite indicator of healthcare quality - for the performance of laparoscopic left lateral sectionectomy (LLLS) and laparoscopic right hepatectomy (LRH) using data from expert centers.
Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all 6 of the following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off laparoscopic liver resection (LLR) volume by center was associated with TO on multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers.
Among 4,400 LLRs performed in 29 centers, 855 patients who underwent LLLS and 488 who underwent LRH were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (odds ratio [OR] 2.45; bootstrap 95% CI 1.65-3.69; p = 0.001) and 35 LLR/year (OR 2.55; bootstrap 95% CI 1.34-5.63; p = 0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers for LLLS and 6 centers for LRH, including 516 and 346 patients undergoing LLLS/LRH respectively, reached these cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%, respectively. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%, respectively.
This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers.
In a nationwide French survey of laparoscopic liver resection, expert centers were defined according to the completion of a textbook outcome, which is a composite indicator of healthcare quality. Benchmark values regarding intra-operative details and outcomes were established using data from 516 patients with laparoscopic left lateral sectionectiomy and 346 patients with laparoscopic right hepatectomy from expert centers. These values should be used as a reference point to improve the quality of laparoscopic resections.
本研究旨在通过专家中心的医疗质量综合指标，为腹腔镜左外叶切除术（LLLS）和腹腔镜右肝切除术（LRH）的性能建立基准值。
对 2000 年至 2017 年间所有接受 LLLS 和 LRH 治疗的患者进行了一项全国多中心调查的数据进行了分析。在满足以下所有 6 个特征的患者中，我们将手术结果的教科书（TO）完成情况视为完成：阴性切缘、无输血、无并发症、无住院时间延长、无再入院和无死亡。对于每个手术，我们通过多元分析确定了中心的腹腔镜肝切除术（LLR）量的截止值，以实现 TO。这些截止值定义了专家中心。基准值设定为这些专家中心的中位数结果的第 75 个百分位数。
在 29 个中心进行的 4400 例 LLR 中，确定了 855 例接受 LLLS 和 488 例接受 LRH 的患者。LLLS 和 LRH 后 TO 的总体发生率分别为 43.7%和 23.8%。LLR 量的截止值为 25 LLR/年（比值比[OR]2.45；自举 95%CI 1.65-3.69；p=0.001）和 35 LLR/年（OR 2.55；bootstrap 95%CI 1.34-5.63；p=0.003）与 LLLS 和 LRH 后 TO 的完成独立相关。有 8 个中心可进行 LLLS，有 6 个中心可进行 LRH，分别包括 516 例和 346 例接受 LLLS/LRH 的患者，达到了这些截止值，被确定为专家中心。在 LLLS 后，严重并发症、死亡率和 TO 完成率的基准值分别定义为≤5.3%、≤1.2%和≥46.6%。在 LRH 后，严重并发症、死亡率和 TO 完成率的基准值分别定义为≤20.4%、≤2.8%和≥24.2%。
本研究为腹腔镜肝切除术在专家中心的基准表现提供了最新参考。
在一项法国全国性的腹腔镜肝切除术调查中，根据完成医疗质量综合指标的教科书结果（TO）来定义专家中心。使用来自专家中心的 516 例腹腔镜左外叶切除术和 346 例腹腔镜右肝切除术患者的数据，建立了关于术中细节和结果的基准值。这些值应作为提高腹腔镜切除术质量的参考点。
