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Benchmark performance of laparoscopic left lateral sectionectomy and right hepatectomy in expert centers

2020; Elsevier BV; Volume: 73; Issue: 5 Linguagem: Inglês

10.1016/j.jhep.2020.05.003

1600-0641

Christian Hobeika, David Fuks, François Cauchy, Claire Goumard, Brice Gayet, Alexis Laurent, Olivier Soubrane, Ephrem Salamé, Daniel Cherqui, Jean‐Marc Regimbeau, Jean‐Yves Mabrut, Olivier Scatton, Éric Vibert, Takeo Nomi, Nassima Oudafal, Takayuki Kawai, Shohei Komatsu, Shinya Okumura, Niccolò Petrucciani, Alexis Laurent, Petru Bucur, Louise Barbier, B. Tréchot, Julio Núñez, Michele Tedeschi, M.-A. Allard, Nicolas Golse, Oriana Ciacio, Gabriella Pittau, António Sá Cunha, René Adam, Christophe Laurent, L. Chiche, P. Léourier, Lionel Rebibo, Jean‐Marc Regimbeau, Laura Ferrè, Régis Souche, Jean Chauvat, J Fabre, François Jehaes, Kayvan Mohkam, Mickaël Lesurtel, Christian Ducerf, Jean‐Yves Mabrut, T. Hor, François Paye, Pierre Balladur, Bertrand Suc, Fabrice Muscari, Guillaume Y. Millet, Mehdi El Amrani, Christine K. Ratajczak, Katia Lécolle, Emmanuel Boleslawski, Stéphanie Truant, F.R. Pruvot, Ali-Reza Kianmanesh, Tatiana Codjia, Lilian Schwarz, Édouard Girard, J. Abba, Christian Létoublon, Mircea Chirica, Abenavoli Carmelo, Charles Vanbrugghe, Zineb Cherkaoui, Xavier Unterteiner, Riccardo Memeo, Patrick Pessaux, Emmanuel Buc, Émilie Lermite, J. Barbieux, M. Bougard, Ugo Marchèse, Jacques Ewald, Olivier Turini, Alexandre Thobie, Benjamin Menahem, A. Mulliri, Jean Lubrano, J. Zemour, H. Fagot, Guillaume Passot, Émilie Grégoire, Jean Hardwigsen, Y.P. Le Treut, D Patrice,

Gallbladder and Bile Duct Disorders

•Laparoscopic left lateral sectionectomies/right hepatectomies from nationwide survey. •Identification of centers with best practices using textbook outcome as indicator. •Benchmarking from outcomes of centers with best practices. •Laparoscopic left lateral sectionectomy: severe complication ≤5%, mortality ≤1%. •Laparoscopic right hepatectomy: severe complication ≤20%, mortality ≤3%. 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. Methods 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. Results 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. Conclusions This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers. Lay summary 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. 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.