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
N1 - Copyright © 2021. Published by Elsevier Ltd.
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 -