Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study

Arthur K E Elfrink; Pim B Olthof; Rutger-Jan Swijnenburg; Marcel den Dulk; Marieke T de Boer; J Sven D Mieog; Jeroen Hagendoorn; Geert Kazemier; Peter B van den Boezem; Arjen M Rijken; Mike S L Liem; Wouter K G Leclercq; Koert F D Kuhlmann; Hendrik A Marsman; Jan N M Ijzermans; Peter van Duijvendijk; Joris I Erdmann; Niels F M Kok; Dirk J Grünhagen; Joost M Klaase; Dutch Hepato Biliary Audit Group

doi:10.1016/j.hpb.2021.04.020

Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study

Arthur K E Elfrink^*, Pim B Olthof, Rutger-Jan Swijnenburg, Marcel den Dulk, Marieke T de Boer, J Sven D Mieog, Jeroen Hagendoorn, Geert Kazemier, Peter B van den Boezem, Arjen M Rijken, Mike S L Liem, Wouter K G Leclercq, Koert F D Kuhlmann, Hendrik A Marsman, Jan N M Ijzermans, Peter van Duijvendijk, Joris I Erdmann, Niels F M Kok, Dirk J Grünhagen, Joost M KlaaseDutch Hepato Biliary Audit Group

^*Corresponding author for this work

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

Abstract

BACKGROUND: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery.

METHODS: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade ≥3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable logistic regression.

RESULTS: Of 4961 patients included, 3707 (74.4%) underwent liver resection for colorectal liver metastases, 379 (7.6%) for other metastases, 526 (10.6%) for hepatocellular carcinoma and 349 (7.0%) for biliary cancer. Thirty-day major morbidity was 11.5%. Overall mortality was 2.3%. FTR was 19.1%. Age 65-80 (aOR: 2.86, CI:1.01-12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66-4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81-9.22, p < 0.001), biliary cancer (aOR:3.47, CI: 1.73-6.96, p < 0.001), and major resection (aOR:6.46, CI: 3.91-10.9, p < 0.001) were associated with FTR. Postoperative liver failure (aOR: 26.9, CI: 14.6-51.2, p < 0.001), cardiac (aOR: 2.62, CI: 1.27-5.29, p = 0.008) and thromboembolic complications (aOR: 2.49, CI: 1.16-5.22, p = 0.017) were associated with FTR. After case-mix correction, no hospital variation in FTR was observed.

CONCLUSION: FTR is influenced by patient demographics, disease and procedural burden. Prevention of postoperative liver failure, cardiac and thromboembolic complications could decrease FTR.

Original language	English
Pages (from-to)	1837-1848
Number of pages	12
Journal	HPB
Volume	23
Issue number	12
DOIs	https://doi.org/10.1016/j.hpb.2021.04.020
Publication status	Published - Dec 2021

Keywords

COLORECTAL-CANCER SURGERY
RISK-ASSESSMENT
HEPATOBILIARY SCINTIGRAPHY
TO-RESCUE
MORTALITY
COMPLICATIONS
VOLUME

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Elfrink, A. K. E., Olthof, P. B., Swijnenburg, R.-J., den Dulk, M., de Boer, M. T., Mieog, J. S. D., Hagendoorn, J., Kazemier, G., van den Boezem, P. B., Rijken, A. M., Liem, M. S. L., Leclercq, W. K. G., Kuhlmann, K. F. D., Marsman, H. A., Ijzermans, J. N. M., van Duijvendijk, P., Erdmann, J. I., Kok, N. F. M., Grünhagen, D. J., ... Dutch Hepato Biliary Audit Group (2021). Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study. HPB, 23(12), 1837-1848. https://doi.org/10.1016/j.hpb.2021.04.020

@article{236a753ba1b740c6a636e9ec7c4ae761,

title = "Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study",

abstract = "BACKGROUND: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery.METHODS: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade ≥3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable logistic regression.RESULTS: Of 4961 patients included, 3707 (74.4\%) underwent liver resection for colorectal liver metastases, 379 (7.6\%) for other metastases, 526 (10.6\%) for hepatocellular carcinoma and 349 (7.0\%) for biliary cancer. Thirty-day major morbidity was 11.5\%. Overall mortality was 2.3\%. FTR was 19.1\%. Age 65-80 (aOR: 2.86, CI:1.01-12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66-4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81-9.22, p < 0.001), biliary cancer (aOR:3.47, CI: 1.73-6.96, p < 0.001), and major resection (aOR:6.46, CI: 3.91-10.9, p < 0.001) were associated with FTR. Postoperative liver failure (aOR: 26.9, CI: 14.6-51.2, p < 0.001), cardiac (aOR: 2.62, CI: 1.27-5.29, p = 0.008) and thromboembolic complications (aOR: 2.49, CI: 1.16-5.22, p = 0.017) were associated with FTR. After case-mix correction, no hospital variation in FTR was observed.CONCLUSION: FTR is influenced by patient demographics, disease and procedural burden. Prevention of postoperative liver failure, cardiac and thromboembolic complications could decrease FTR.",

keywords = "COLORECTAL-CANCER SURGERY, RISK-ASSESSMENT, HEPATOBILIARY SCINTIGRAPHY, TO-RESCUE, MORTALITY, COMPLICATIONS, VOLUME",

author = "Elfrink, \{Arthur K E\} and Olthof, \{Pim B\} and Rutger-Jan Swijnenburg and \{den Dulk\}, Marcel and \{de Boer\}, \{Marieke T\} and Mieog, \{J Sven D\} and Jeroen Hagendoorn and Geert Kazemier and \{van den Boezem\}, \{Peter B\} and Rijken, \{Arjen M\} and Liem, \{Mike S L\} and Leclercq, \{Wouter K G\} and Kuhlmann, \{Koert F D\} and Marsman, \{Hendrik A\} and Ijzermans, \{Jan N M\} and \{van Duijvendijk\}, Peter and Erdmann, \{Joris I\} and Kok, \{Niels F M\} and Gr{\"u}nhagen, \{Dirk J\} and Klaase, \{Joost M\} and \{Dutch Hepato Biliary Audit Group\}",

note = "Copyright {\textcopyright} 2021. Published by Elsevier Ltd.",

year = "2021",

month = dec,

doi = "10.1016/j.hpb.2021.04.020",

language = "English",

volume = "23",

pages = "1837--1848",

journal = "HPB",

issn = "1365-182X",

publisher = "Elsevier B.V.",

number = "12",

}

Elfrink, AKE, Olthof, PB, Swijnenburg, R-J, den Dulk, M, de Boer, MT, Mieog, JSD, Hagendoorn, J, Kazemier, G, van den Boezem, PB, Rijken, AM, Liem, MSL, Leclercq, WKG, Kuhlmann, KFD, Marsman, HA, Ijzermans, JNM, van Duijvendijk, P, Erdmann, JI, Kok, NFM, Grünhagen, DJ, Klaase, JM & Dutch Hepato Biliary Audit Group 2021, 'Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study', HPB, vol. 23, no. 12, pp. 1837-1848. https://doi.org/10.1016/j.hpb.2021.04.020

TY - JOUR

T1 - Factors associated with failure to rescue after liver resection and impact on hospital variation

T2 - a nationwide population-based study

AU - Elfrink, Arthur K E

AU - Olthof, Pim B

AU - Swijnenburg, Rutger-Jan

AU - den Dulk, Marcel

AU - de Boer, Marieke T

AU - Mieog, J Sven D

AU - Hagendoorn, Jeroen

AU - Kazemier, Geert

AU - van den Boezem, Peter B

AU - Rijken, Arjen M

AU - Liem, Mike S L

AU - Leclercq, Wouter K G

AU - Kuhlmann, Koert F D

AU - Marsman, Hendrik A

AU - Ijzermans, Jan N M

AU - van Duijvendijk, Peter

AU - Erdmann, Joris I

AU - Kok, Niels F M

AU - Grünhagen, Dirk J

AU - Klaase, Joost M

AU - Dutch Hepato Biliary Audit Group

PY - 2021/12

Y1 - 2021/12

N2 - BACKGROUND: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery.METHODS: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade ≥3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable logistic regression.RESULTS: Of 4961 patients included, 3707 (74.4%) underwent liver resection for colorectal liver metastases, 379 (7.6%) for other metastases, 526 (10.6%) for hepatocellular carcinoma and 349 (7.0%) for biliary cancer. Thirty-day major morbidity was 11.5%. Overall mortality was 2.3%. FTR was 19.1%. Age 65-80 (aOR: 2.86, CI:1.01-12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66-4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81-9.22, p < 0.001), biliary cancer (aOR:3.47, CI: 1.73-6.96, p < 0.001), and major resection (aOR:6.46, CI: 3.91-10.9, p < 0.001) were associated with FTR. Postoperative liver failure (aOR: 26.9, CI: 14.6-51.2, p < 0.001), cardiac (aOR: 2.62, CI: 1.27-5.29, p = 0.008) and thromboembolic complications (aOR: 2.49, CI: 1.16-5.22, p = 0.017) were associated with FTR. After case-mix correction, no hospital variation in FTR was observed.CONCLUSION: FTR is influenced by patient demographics, disease and procedural burden. Prevention of postoperative liver failure, cardiac and thromboembolic complications could decrease FTR.

AB - BACKGROUND: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery.METHODS: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade ≥3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable logistic regression.RESULTS: Of 4961 patients included, 3707 (74.4%) underwent liver resection for colorectal liver metastases, 379 (7.6%) for other metastases, 526 (10.6%) for hepatocellular carcinoma and 349 (7.0%) for biliary cancer. Thirty-day major morbidity was 11.5%. Overall mortality was 2.3%. FTR was 19.1%. Age 65-80 (aOR: 2.86, CI:1.01-12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66-4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81-9.22, p < 0.001), biliary cancer (aOR:3.47, CI: 1.73-6.96, p < 0.001), and major resection (aOR:6.46, CI: 3.91-10.9, p < 0.001) were associated with FTR. Postoperative liver failure (aOR: 26.9, CI: 14.6-51.2, p < 0.001), cardiac (aOR: 2.62, CI: 1.27-5.29, p = 0.008) and thromboembolic complications (aOR: 2.49, CI: 1.16-5.22, p = 0.017) were associated with FTR. After case-mix correction, no hospital variation in FTR was observed.CONCLUSION: FTR is influenced by patient demographics, disease and procedural burden. Prevention of postoperative liver failure, cardiac and thromboembolic complications could decrease FTR.

KW - COLORECTAL-CANCER SURGERY

KW - RISK-ASSESSMENT

KW - HEPATOBILIARY SCINTIGRAPHY

KW - TO-RESCUE

KW - MORTALITY

KW - COMPLICATIONS

KW - VOLUME

U2 - 10.1016/j.hpb.2021.04.020

DO - 10.1016/j.hpb.2021.04.020

M3 - Article

C2 - 34090804

SN - 1365-182X

VL - 23

SP - 1837

EP - 1848

JO - HPB

JF - HPB

IS - 12

ER -

Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study

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Keywords

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