A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma

Katiuscha Merath, Qinyu Chen, Fabio Bagante, Sorin Alexandrescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Matthew J Weiss, Todd W. Bauer, Feng Shen, George A. Poultsides, Olivier Soubrane, Guillaume Martel, B. Groot Koerkamp, Alfredo Guglielmi, Endo Itaru, Jordan M. Cloyd, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Importance: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care. Objective: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. Design, Setting, and Participants: This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018. Main Outcomes and Measures: Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes. Results: Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P =.03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P =.02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P =.04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P =.049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P =.001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P =.009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763). Conclusions and Relevance: In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma..

Original languageEnglish (US)
JournalJAMA surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cholangiocarcinoma
Textbooks
Odds Ratio
Quality of Health Care
Area Under Curve
Length of Stay
Nomograms
Mortality
North America
Quality Improvement
Jaundice
Bile Ducts
Cohort Studies
Outcome Assessment (Health Care)
Drug Therapy
Liver
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. / Merath, Katiuscha; Chen, Qinyu; Bagante, Fabio; Alexandrescu, Sorin; Marques, Hugo P.; Aldrighetti, Luca; Maithel, Shishir K.; Pulitano, Carlo; Weiss, Matthew J; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Soubrane, Olivier; Martel, Guillaume; Koerkamp, B. Groot; Guglielmi, Alfredo; Itaru, Endo; Cloyd, Jordan M.; Pawlik, Timothy M.

In: JAMA surgery, 01.01.2019.

Research output: Contribution to journalArticle

Merath, K, Chen, Q, Bagante, F, Alexandrescu, S, Marques, HP, Aldrighetti, L, Maithel, SK, Pulitano, C, Weiss, MJ, Bauer, TW, Shen, F, Poultsides, GA, Soubrane, O, Martel, G, Koerkamp, BG, Guglielmi, A, Itaru, E, Cloyd, JM & Pawlik, TM 2019, 'A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma', JAMA surgery. https://doi.org/10.1001/jamasurg.2019.0571
Merath, Katiuscha ; Chen, Qinyu ; Bagante, Fabio ; Alexandrescu, Sorin ; Marques, Hugo P. ; Aldrighetti, Luca ; Maithel, Shishir K. ; Pulitano, Carlo ; Weiss, Matthew J ; Bauer, Todd W. ; Shen, Feng ; Poultsides, George A. ; Soubrane, Olivier ; Martel, Guillaume ; Koerkamp, B. Groot ; Guglielmi, Alfredo ; Itaru, Endo ; Cloyd, Jordan M. ; Pawlik, Timothy M. / A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. In: JAMA surgery. 2019.
@article{226ef6d828df45458132e2042dcb1aac,
title = "A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma",
abstract = "Importance: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care. Objective: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. Design, Setting, and Participants: This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018. Main Outcomes and Measures: Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes. Results: Among 687 patients (of whom 370 [53.9{\%}] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5{\%}). Being 60 years or younger (odds ratio [OR], 1.61 [95{\%} CI, 1.04-2.49]; P =.03), absence of preoperative jaundice (OR, 4.40 [95{\%} CI, 1.28-15.15]; P =.02), no neoadjuvant chemotherapy (OR, 2.57 [95{\%} CI, 1.05-6.29]; P =.04), T1a/T1b-stage disease (OR, 1.58 [95{\%} CI, 1.01-2.49]; P =.049), N0 status (OR, 3.89 [95{\%} CI, 1.77-8.54]; P =.001), and no bile duct resection (OR, 2.46 [95{\%} CI, 1.25-4.84]; P =.009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763). Conclusions and Relevance: In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5{\%} mortality in specialized centers, a textbook outcome was achieved in only approximately 26{\%} of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma..",
author = "Katiuscha Merath and Qinyu Chen and Fabio Bagante and Sorin Alexandrescu and Marques, {Hugo P.} and Luca Aldrighetti and Maithel, {Shishir K.} and Carlo Pulitano and Weiss, {Matthew J} and Bauer, {Todd W.} and Feng Shen and Poultsides, {George A.} and Olivier Soubrane and Guillaume Martel and Koerkamp, {B. Groot} and Alfredo Guglielmi and Endo Itaru and Cloyd, {Jordan M.} and Pawlik, {Timothy M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamasurg.2019.0571",
language = "English (US)",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",

}

TY - JOUR

T1 - A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma

AU - Merath, Katiuscha

AU - Chen, Qinyu

AU - Bagante, Fabio

AU - Alexandrescu, Sorin

AU - Marques, Hugo P.

AU - Aldrighetti, Luca

AU - Maithel, Shishir K.

AU - Pulitano, Carlo

AU - Weiss, Matthew J

AU - Bauer, Todd W.

AU - Shen, Feng

AU - Poultsides, George A.

AU - Soubrane, Olivier

AU - Martel, Guillaume

AU - Koerkamp, B. Groot

AU - Guglielmi, Alfredo

AU - Itaru, Endo

AU - Cloyd, Jordan M.

AU - Pawlik, Timothy M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care. Objective: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. Design, Setting, and Participants: This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018. Main Outcomes and Measures: Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes. Results: Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P =.03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P =.02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P =.04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P =.049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P =.001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P =.009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763). Conclusions and Relevance: In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma..

AB - Importance: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care. Objective: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. Design, Setting, and Participants: This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018. Main Outcomes and Measures: Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes. Results: Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P =.03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P =.02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P =.04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P =.049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P =.001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P =.009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763). Conclusions and Relevance: In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma..

UR - http://www.scopus.com/inward/record.url?scp=85064899770&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064899770&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2019.0571

DO - 10.1001/jamasurg.2019.0571

M3 - Article

C2 - 31017645

AN - SCOPUS:85064899770

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

ER -