Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, the Netherlands.
Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, the Netherlands.
Eur J Surg Oncol. 2024 Jun;50(6):108264. doi: 10.1016/j.ejso.2024.108264. Epub 2024 Mar 16.
In 2013, the nationwide Dutch Hepato Biliary Audit (DHBA) was initiated. The aim of this study was to evaluate changes in indications for and outcomes of liver surgery in the last decade.
This nationwide study included all patients who underwent liver surgery for four indications, including colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), and intrahepatic- and perihilar cholangiocarcinoma (iCCA - pCCA) between 2014 and 2022. Trends in postoperative outcomes were evaluated separately for each indication using multilevel multivariable logistic regression analyses.
This study included 8057 procedures for CRLM, 838 for HCC, 290 for iCCA, and 300 for pCCA. Over time, these patients had higher risk profiles (more ASA-III patients and more comorbidities). Adjusted mortality decreased over time for CRLM, HCC and iCCA, respectively aOR 0.83, 95%CI 0.75-0.92, P < 0.001; aOR 0.86, 95%CI 0.75-0.99, P = 0.045; aOR 0.40, 95%CI 0.20-0.73, P < 0.001. Failure to rescue (FTR) also decreased for these groups, respectively aOR 0.84, 95%CI 0.76-0.93, P = 0.001; aOR 0.81, 95%CI 0.68-0.97, P = 0.024; aOR 0.29, 95%CI 0.08-0.84, P = 0.021). For iCCA severe complications (aOR 0.65 95%CI 0.43-0.99, P = 0.043) also decreased. No significant outcome differences were observed in pCCA. The number of centres performing liver resections decreased from 26 to 22 between 2014 and 2022, while median annual volumes did not change (40-49, P = 0.66).
Over time, postoperative mortality and FTR decreased after liver surgery, despite treating higher-risk patients. The DHBA continues its focus on providing feedback and benchmark results to further enhance outcomes.
2013 年，启动了全国性的荷兰肝胆审计（DHBA）。本研究的目的是评估过去十年中肝外科手术适应证和结果的变化。
本项全国性研究纳入了 2014 年至 2022 年间因结直肠肝转移（CRLM）、肝细胞癌（HCC）、肝内和肝门部胆管癌（iCCA-pCCA）四种适应证接受肝切除术的所有患者。分别使用多水平多变量逻辑回归分析评估每个适应证的术后结局变化趋势。
本研究共纳入 8057 例 CRLM、838 例 HCC、290 例 iCCA 和 300 例 pCCA 手术。随着时间的推移，这些患者的风险状况更高（更多的 ASA-III 患者和更多的合并症）。CRLM、HCC 和 iCCA 的调整死亡率分别呈下降趋势，aOR 分别为 0.83、95%CI 0.75-0.92、P<0.001；aOR 0.86、95%CI 0.75-0.99、P=0.045；aOR 0.40、95%CI 0.20-0.73、P<0.001。这些组的抢救失败（FTR）也有所减少，aOR 分别为 0.84、95%CI 0.76-0.93、P=0.001；aOR 0.81、95%CI 0.68-0.97、P=0.024；aOR 0.29、95%CI 0.08-0.84、P=0.021。iCCA 的严重并发症（aOR 0.65、95%CI 0.43-0.99、P=0.043）也有所减少。pCCA 的结果无显著差异。2014 年至 2022 年间，行肝切除术的中心数量从 26 家减少至 22 家，而中位年度手术量无变化（40-49，P=0.66）。
尽管治疗的是高风险患者，但随着时间的推移，肝手术后的死亡率和 FTR 有所下降。DHBA 将继续关注提供反馈和基准结果，以进一步提高结果。
