Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

A.K.E. Elfrink; E.W. van Zwet; R.J. Swijnenburg; M. den Dulk; P.B. van den Boezem; J.S.D. Mieog; W.W. te Riele; G.A. Patijn; W.K.G. Leclercq; D.J. Lips; A.M. Rijken; C. Verhoef; K.F.D. Kuhlmann; C.I. Buis; K. Bosscha; E.J.T. Belt; M. Vermaas; N.T. van Heek; S.J. Oosterling; H. Torrenga; H.H. Eker; E.C.J. Consten; H.A. Marsman; M.W.J.M. Wouters; N.F.M. Kok; D.J. Grunhagen; J.M. Klaase; Dutch Hepato Biliary Audit Group

doi:10.1016/j.ejso.2020.10.016

Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

A.K.E. Elfrink^*, E.W. van Zwet, R.J. Swijnenburg, M. den Dulk, P.B. van den Boezem, J.S.D. Mieog, W.W. te Riele, G.A. Patijn, W.K.G. Leclercq, D.J. Lips, A.M. Rijken, C. Verhoef, K.F.D. Kuhlmann, C.I. Buis, K. Bosscha, E.J.T. Belt, M. Vermaas, N.T. van Heek, S.J. Oosterling, H. TorrengaH.H. Eker, E.C.J. Consten, H.A. Marsman, M.W.J.M. Wouters, N.F.M. Kok, D.J. Grunhagen, J.M. Klaase, Dutch Hepato Biliary Audit Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM).

Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019.

Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes.

Conclusion: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM. (C) 2020 University Medical Center Groningen. Published by Elsevier Ltd.

Original language	English
Pages (from-to)	649-659
Number of pages	11
Journal	European Journal of Surgical Oncology
Volume	47
Issue number	3
DOIs	https://doi.org/10.1016/j.ejso.2020.10.016
Publication status	Published - 1 Mar 2021

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Elfrink, A. K. E., van Zwet, E. W., Swijnenburg, R. J., den Dulk, M., van den Boezem, P. B., Mieog, J. S. D., te Riele, W. W., Patijn, G. A., Leclercq, W. K. G., Lips, D. J., Rijken, A. M., Verhoef, C., Kuhlmann, K. F. D., Buis, C. I., Bosscha, K., Belt, E. J. T., Vermaas, M., van Heek, N. T., Oosterling, S. J., ... Dutch Hepato Biliary Audit Group (2021). Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases. European Journal of Surgical Oncology, 47(3), 649-659. https://doi.org/10.1016/j.ejso.2020.10.016

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title = "Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases",

abstract = "Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM).Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019.Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes.Conclusion: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM. (C) 2020 University Medical Center Groningen. Published by Elsevier Ltd.",

author = "A.K.E. Elfrink and {van Zwet}, E.W. and R.J. Swijnenburg and {den Dulk}, M. and {van den Boezem}, P.B. and J.S.D. Mieog and {te Riele}, W.W. and G.A. Patijn and W.K.G. Leclercq and D.J. Lips and A.M. Rijken and C. Verhoef and K.F.D. Kuhlmann and C.I. Buis and K. Bosscha and E.J.T. Belt and M. Vermaas and {van Heek}, N.T. and S.J. Oosterling and H. Torrenga and H.H. Eker and E.C.J. Consten and H.A. Marsman and M.W.J.M. Wouters and N.F.M. Kok and D.J. Grunhagen and J.M. Klaase and {Dutch Hepato Biliary Audit Group}",

note = "Publisher Copyright: {\textcopyright} 2020 University Medical Center Groningen",

year = "2021",

month = mar,

day = "1",

doi = "10.1016/j.ejso.2020.10.016",

language = "English",

volume = "47",

pages = "649--659",

journal = "European Journal of Surgical Oncology",

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Elfrink, AKE, van Zwet, EW, Swijnenburg, RJ, den Dulk, M, van den Boezem, PB, Mieog, JSD, te Riele, WW, Patijn, GA, Leclercq, WKG, Lips, DJ, Rijken, AM, Verhoef, C, Kuhlmann, KFD, Buis, CI, Bosscha, K, Belt, EJT, Vermaas, M, van Heek, NT, Oosterling, SJ, Torrenga, H, Eker, HH, Consten, ECJ, Marsman, HA, Wouters, MWJM, Kok, NFM, Grunhagen, DJ, Klaase, JM & Dutch Hepato Biliary Audit Group 2021, 'Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases', European Journal of Surgical Oncology, vol. 47, no. 3, pp. 649-659. https://doi.org/10.1016/j.ejso.2020.10.016

TY - JOUR

T1 - Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

AU - Elfrink, A.K.E.

AU - van Zwet, E.W.

AU - Swijnenburg, R.J.

AU - den Dulk, M.

AU - van den Boezem, P.B.

AU - Mieog, J.S.D.

AU - te Riele, W.W.

AU - Patijn, G.A.

AU - Leclercq, W.K.G.

AU - Lips, D.J.

AU - Rijken, A.M.

AU - Verhoef, C.

AU - Kuhlmann, K.F.D.

AU - Buis, C.I.

AU - Bosscha, K.

AU - Belt, E.J.T.

AU - Vermaas, M.

AU - van Heek, N.T.

AU - Oosterling, S.J.

AU - Torrenga, H.

AU - Eker, H.H.

AU - Consten, E.C.J.

AU - Marsman, H.A.

AU - Wouters, M.W.J.M.

AU - Kok, N.F.M.

AU - Grunhagen, D.J.

AU - Klaase, J.M.

AU - Dutch Hepato Biliary Audit Group

PY - 2021/3/1

Y1 - 2021/3/1

N2 - Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM).Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019.Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes.Conclusion: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM. (C) 2020 University Medical Center Groningen. Published by Elsevier Ltd.

AB - Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM).Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019.Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes.Conclusion: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM. (C) 2020 University Medical Center Groningen. Published by Elsevier Ltd.

U2 - 10.1016/j.ejso.2020.10.016

DO - 10.1016/j.ejso.2020.10.016

M3 - Article

C2 - 33183927

SN - 0748-7983

VL - 47

SP - 649

EP - 659

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 3

ER -