de Graaff Michelle R, Elfrink Arthur K E, Buis Carlijn I, Swijnenburg Rutger-Jan, Erdmann Joris I, Kazemier Geert, Verhoef Cornelis, Mieog J Sven D, Derksen Wouter J M, van den Boezem Peter B, Ayez Ninos, Liem Mike S L, Leclercq Wouter K G, Kuhlmann Koert F D, Marsman Hendrik A, van Duijvendijk Peter, Kok Niels F M, Klaase Joost M, Dejong Cornelis H C, Grünhagen Dirk J, den Dulk Marcel
Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands.
Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Eur J Surg Oncol. 2022 Dec;48(12):2414-2423. doi: 10.1016/j.ejso.2022.06.012. Epub 2022 Jun 20.
Textbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery.
This was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment.
2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51-0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44-0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34-0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54-0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36-0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed.
TO differs between indications for liver resection and can be used to assess between hospital and network differences.
教科书式结局（TO）是一种综合结局指标，涵盖了单一结局指标中的手术护理过程。与事件发生率较低的单一结局参数相比，TO具有优势，因为单一结局参数对检测医院之间的差异影响较小。本研究旨在评估与TO相关的因素，并在对肝手术的TO率进行病例组合校正后，评估医院和网络之间的差异。
这是一项基于人群的回顾性研究，研究对象为2019年和2020年在荷兰接受恶性肿瘤肝切除术的所有患者。TO定义为无严重术后并发症、无死亡、无住院时间延长和再入院，且获得足够的切缘。采用多变量逻辑回归进行病例组合调整。
共纳入2376例患者。结直肠癌肝转移患者中有1380例（80%）实现了TO，其他肝转移患者中有192例（76%），肝细胞癌患者中有183例（74%），胆管癌患者中有86例（51%）。与CRLM的TO率较低相关的因素包括美国麻醉医师协会（ASA）评分≥3（调整后比值比[aOR]0.70，可信区间[CI]0.51-0.95，p = 0.02）、肝外疾病（aOR 0.64，CI 0.44-0.95，p = 0.02）、术前影像学检查显示肿瘤大小>55 mm（aOR 0.56，CI 0.34-0.94，p = 0.02）、查尔森合并症指数≥2（aOR 0.73，CI 0.54-0.98，p = 0.04）以及肝大部切除术（aOR 0.50，CI 0.36-0.69，p < 0.001）。在进行病例组合校正后，未观察到显著的医院或肿瘤学网络差异。
肝切除适应证之间的TO存在差异，可用于评估医院和网络之间的差异。
