Teng Da, Xu Yue
Department of Hepatobiliary Pancreatic and Splenic Surgery Ward Ⅰ, The Affiliated ChuZhou Hospital of Anhui Medical University (The First People's Hospital of ChuZhou), ChuZhou, China.
Department of Ultrasound Medicine, The Affiliated ChuZhou Hospital of Anhui Medical University (The First People's Hospital of ChuZhou), ChuZhou, China.
Front Surg. 2025 Aug 14;12:1623559. doi: 10.3389/fsurg.2025.1623559. eCollection 2025.
The textbook outcome (TO) is an innovative composite criterion that encompasses multiple perioperative events. It serves as a measure of perioperative quality and provides an objective reflection of the most desirable outcome. The concept of TO has been introduced to laparoscopic common bile duct exploration (LCBDE) to establish TO criteria and identify key risk factors associated with TO failure.
Clinical data from 225 patients who underwent LCBDE for choledocholithiasis were retrospectively analyzed, categorizing them into "TO" and "TO-failure" groups based on whether TO was achieved. TO criteria were defined based on existing literature and the perioperative characteristics of LCBDE, including no residual stones, no bile leakage, no severe postoperative complications, no readmission or death within 30 days, and no extended hospitalization. The TO incidence rate was calculated, and univariate and multivariate logistic regression analyses were employed to identify perioperative characteristics and independent risk factors contributing to TO failure.
A total of 167 patients (74.2%) achieved TO. Independent risk factors for TO failure included ASA score ≥ 3 (OR: 9.260, 95% CI: 2.292-37.418, = 0.002), T-tube drainage (TTD) (OR: 5.332, 95% CI: 1.625-17.497, = 0.006), preoperative combined cholecystitis (OR: 3.448, 95% CI: 1.091-10.897, = 0.035), preoperative combined cholangitis (OR: 11.468, 95% CI: 2.841-46.284, = 0.001), and operative time ≥ 90 min (OR: 3.066, 95% CI: 1.253-7.503, = 0.014).
Applying the TO concept to LCBDE facilitates a more comprehensive and objective evaluation of perioperative characteristics in patients with choledocholithiasis. This approach contributes to the standardization of quality assessment in LCBDE, promoting the continuous improvement of surgical quality. Furthermore, achieving TO can enhance the overall quality of the healthcare system, potentially reducing healthcare costs. Additionally, TO aligns more closely with patient preferences, representing the optimal surgical outcome. As a holistic assessment tool, TO is poised to become a definitive quality standard for evaluating surgical procedures.
教科书式结局（TO）是一种创新的综合标准，涵盖多个围手术期事件。它作为围手术期质量的一种衡量标准，客观反映了最理想的结局。TO的概念已被引入腹腔镜胆总管探查术（LCBDE），以建立TO标准并识别与TO失败相关的关键风险因素。
回顾性分析225例行LCBDE治疗胆总管结石患者的临床资料，根据是否达到TO将其分为“TO”组和“TO失败”组。基于现有文献和LCBDE的围手术期特征定义TO标准，包括无残留结石、无胆漏、无严重术后并发症、30天内无再次入院或死亡以及无延长住院时间。计算TO发生率，并采用单因素和多因素逻辑回归分析来识别围手术期特征和导致TO失败的独立风险因素。
共有167例患者（74.2%）达到TO。TO失败的独立风险因素包括美国麻醉医师协会（ASA）评分≥3（比值比[OR]：9.260，95%置信区间[CI]：2.292 - 37.418，P = 0.002）、T管引流（TTD）（OR：5.332，95% CI：1.625 - 17.497，P = 0.006）、术前合并胆囊炎（OR：3.448，95% CI：1.091 - 10.897，P = 0.035）、术前合并胆管炎（OR：11.468，95% CI：2.841 - 46.284，P = 0.001）以及手术时间≥90分钟（OR：3.066，95% CI：1.253 - 7.503，P = 0.014）。
将TO概念应用于LCBDE有助于更全面、客观地评估胆总管结石患者的围手术期特征。这种方法有助于LCBDE质量评估的标准化，促进手术质量的持续提高。此外，实现TO可提高医疗系统的整体质量，可能降低医疗成本。此外，TO更符合患者偏好，代表了最佳手术结局。作为一种整体评估工具，TO有望成为评估手术程序的权威性质量标准。
