Int J Surg. 2023 Dec 1;109(12):3954-3966. doi: 10.1097/JS9.0000000000000711.
The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.
LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January-December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien-Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141).
A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively.
This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.
全球范围内的肝脏手术结果仍不清楚。真实的基于人群的结果可能与那些反映高度专业化学术中心活动的结果大不相同。本研究的目的是通过在全球范围内招募中心来衡量真正的全球肝脏手术实践及其相关结果。还评估了肝脏手术活动和复杂性的地理分布，以进一步了解结果的差异。
LiverGroup.org 是一项国际、前瞻性、多中心、横断面研究，采用全球外科协作快照研究方法，在 2019 年 1 月至 12 月期间进行了为期 3 个月的前瞻性连续患者入组。每个患者在术后 90 天内进行随访。所有在各自中心接受肝脏手术的患者均符合研究纳入标准。收集基本人口统计学、患者和手术特征。根据手术并发症的 Clavien-Dindo 分类记录发病率。收集基于国家和医院的数据，包括人类发展指数 (HDI)。（NCT03768141）。
共纳入来自六大洲的 2159 名患者。1785 名（83%）患者因癌症进行了手术。所有患者中有 912 名（42%）经历了任何严重程度的术后并发症，而主要并发症发生率为 16%（341/2159）。肝脏手术后 90 天的总体死亡率为 3.8%（82/2159）。总体救援失败率为 11%（82/722），在人类发展指数较高和较低的组中分别为 5%至 35%。
这是我们所知的第一个专门针对专业肝脏手术设计和进行的全球外科手术研究。作者确定救援失败是肝脏手术后死亡的一个重要的潜在可改变因素，主要与人类发展指数较低的国家有关。LiverGroup.org 网络的成员现在可以共同努力，开展质量改进合作。
