Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Arthur K. E. Elfrink; Sanne Nieuwenhuizen; M. Petrousjka van den Tol; Mark C. Burgmans; Warner Prevoo; Marielle M. E. Coolsen; Peter B. van den Boezem; Otto M. van Delden; Jeroen Hagendoorn; Gijs A. Patijn; Wouter K. G. Leclercq; Mike S. L. Liem; Arjen M. Rijken; Cornelis Verhoef; Koert F. D. Kuhlmann; Simeon J. S. Ruiter; Dirk J. Grunhagen; Joost M. Klaase; Niels F. M. Kok; Martijn R. Meijerink; Rutger-Jan Swijnenburg; Dutch Hepato Biliary Audit Group

doi:10.1016/j.hpb.2020.10.003

Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Arthur K. E. Elfrink^*, Sanne Nieuwenhuizen, M. Petrousjka van den Tol, Mark C. Burgmans, Warner Prevoo, Marielle M. E. Coolsen, Peter B. van den Boezem, Otto M. van Delden, Jeroen Hagendoorn, Gijs A. Patijn, Wouter K. G. Leclercq, Mike S. L. Liem, Arjen M. Rijken, Cornelis Verhoef, Koert F. D. Kuhlmann, Simeon J. S. Ruiter, Dirk J. Grunhagen, Joost M. Klaase, Niels F. M. Kok, Martijn R. MeijerinkRutger-Jan Swijnenburg, Dutch Hepato Biliary Audit Group

^*Corresponding author for this work

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

Abstract

Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation.

Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery.

Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy.

Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.

Original language	English
Pages (from-to)	827-839
Number of pages	13
Journal	HPB
Volume	23
Issue number	6
DOIs	https://doi.org/10.1016/j.hpb.2020.10.003
Publication status	Published - Jun 2021

Keywords

INTRAOPERATIVE RADIOFREQUENCY ABLATION
PARENCHYMAL SPARING SURGERY
MICROWAVE ABLATION
HEPATIC RESECTION
COMPLICATIONS
CANCER

Access to Document

10.1016/j.hpb.2020.10.003Licence: CC BY

Cite this

Elfrink, A. K. E., Nieuwenhuizen, S., van den Tol, M. P., Burgmans, M. C., Prevoo, W., Coolsen, M. M. E., van den Boezem, P. B., van Delden, O. M., Hagendoorn, J., Patijn, G. A., Leclercq, W. K. G., Liem, M. S. L., Rijken, A. M., Verhoef, C., Kuhlmann, K. F. D., Ruiter, S. J. S., Grunhagen, D. J., Klaase, J. M., Kok, N. F. M., ... Dutch Hepato Biliary Audit Group (2021). Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study. HPB, 23(6), 827-839. https://doi.org/10.1016/j.hpb.2020.10.003

@article{9f14509118584806b4ceae24611c3b9c,

title = "Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study",

abstract = "Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation.Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery.Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy.Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.",

keywords = "INTRAOPERATIVE RADIOFREQUENCY ABLATION, PARENCHYMAL SPARING SURGERY, MICROWAVE ABLATION, HEPATIC RESECTION, COMPLICATIONS, CANCER",

author = "Elfrink, {Arthur K. E.} and Sanne Nieuwenhuizen and {van den Tol}, {M. Petrousjka} and Burgmans, {Mark C.} and Warner Prevoo and Coolsen, {Marielle M. E.} and {van den Boezem}, {Peter B.} and {van Delden}, {Otto M.} and Jeroen Hagendoorn and Patijn, {Gijs A.} and Leclercq, {Wouter K. G.} and Liem, {Mike S. L.} and Rijken, {Arjen M.} and Cornelis Verhoef and Kuhlmann, {Koert F. D.} and Ruiter, {Simeon J. S.} and Grunhagen, {Dirk J.} and Klaase, {Joost M.} and Kok, {Niels F. M.} and Meijerink, {Martijn R.} and Rutger-Jan Swijnenburg and {Dutch Hepato Biliary Audit Group}",

year = "2021",

month = jun,

doi = "10.1016/j.hpb.2020.10.003",

language = "English",

volume = "23",

pages = "827--839",

journal = "HPB",

issn = "1365-182X",

publisher = "ELSEVIER SCI LTD",

number = "6",

}

Elfrink, AKE, Nieuwenhuizen, S, van den Tol, MP, Burgmans, MC, Prevoo, W, Coolsen, MME, van den Boezem, PB, van Delden, OM, Hagendoorn, J, Patijn, GA, Leclercq, WKG, Liem, MSL, Rijken, AM, Verhoef, C, Kuhlmann, KFD, Ruiter, SJS, Grunhagen, DJ, Klaase, JM, Kok, NFM, Meijerink, MR, Swijnenburg, R-J & Dutch Hepato Biliary Audit Group 2021, 'Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study', HPB, vol. 23, no. 6, pp. 827-839. https://doi.org/10.1016/j.hpb.2020.10.003

Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study. / Elfrink, Arthur K. E.; Nieuwenhuizen, Sanne; van den Tol, M. Petrousjka et al.
In: HPB, Vol. 23, No. 6, 06.2021, p. 827-839.

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

TY - JOUR

T1 - Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes

T2 - a nationwide population-based study

AU - Elfrink, Arthur K. E.

AU - Nieuwenhuizen, Sanne

AU - van den Tol, M. Petrousjka

AU - Burgmans, Mark C.

AU - Prevoo, Warner

AU - Coolsen, Marielle M. E.

AU - van den Boezem, Peter B.

AU - van Delden, Otto M.

AU - Hagendoorn, Jeroen

AU - Patijn, Gijs A.

AU - Leclercq, Wouter K. G.

AU - Liem, Mike S. L.

AU - Rijken, Arjen M.

AU - Verhoef, Cornelis

AU - Kuhlmann, Koert F. D.

AU - Ruiter, Simeon J. S.

AU - Grunhagen, Dirk J.

AU - Klaase, Joost M.

AU - Kok, Niels F. M.

AU - Meijerink, Martijn R.

AU - Swijnenburg, Rutger-Jan

AU - Dutch Hepato Biliary Audit Group

PY - 2021/6

Y1 - 2021/6

N2 - Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation.Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery.Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy.Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.

AB - Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation.Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery.Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy.Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.

KW - INTRAOPERATIVE RADIOFREQUENCY ABLATION

KW - PARENCHYMAL SPARING SURGERY

KW - MICROWAVE ABLATION

KW - HEPATIC RESECTION

KW - COMPLICATIONS

KW - CANCER

U2 - 10.1016/j.hpb.2020.10.003

DO - 10.1016/j.hpb.2020.10.003

M3 - Article

C2 - 33218949

SN - 1365-182X

VL - 23

SP - 827

EP - 839

JO - HPB

JF - HPB

IS - 6

ER -