Defining benchmarks for major liver surgery: A multicenter analysis of 5202 living liver donors

Fabian Rössler, Gonzalo Sapisochin, Gi Won Song, Yu Hung Lin, Mary Ann Simpson, Kiyoshi Hasegawa, Andrea Laurenzi, Santiago Sánchez Cabús, Milton Inostroza Nunez, Andrea Gatti, Magali Chahdi Beltrame, Ksenija Slankamenac, Paul D. Greig, Sung Gyu Lee, Chao Long Chen, David R. Grant, Elizabeth A. Pomfret, Norihiro Kokudo, Daniel Cherqui, Kim M. OlthoffAbraham Shaked, Juan Carlos García-Valdecasas, Jan Lerut, Roberto I. Troisi, Martin De Santibanes, Henrik Petrowsky, Milo A. Puhan, Pierre Alain Clavien

Research output: Contribution to journalArticle

Abstract

Objective: To measure and define the best achievable outcome after major hepatectomy. Background: No reference values are available on outcomes after major hepatectomies. Analysis in living liver donors, with safety as the highest priority, offers the opportunity to define outcome benchmarks as the best possible results. Methods: Outcome analyses of 5202 hemi-hepatectomies from living donors (LDs) from 12 high-volume centers worldwide were performed for a 10-year period. Endpoints, calculated at discharge, 3 and 6 months postoperatively, included postoperative morbidity measured by the Clavien-Dindo classification, the Comprehensive Complication Index (CCI), and liver failure according to different definitions. Benchmark values were defined as the 75th percentile of median morbidity values to represent the best achievable results at 3 month postoperatively. Results: Patients were young (34 ± [9] years), predominantly male (65%) and healthy. Surgery lasted 7 ± [2] hours; 2% needed blood transfusions. Mean hospital stay was 11.7 ± [5] days. 12% of patients developed at least 1 complication, of which 3.8% were major events (≥grade III, including 1 death), mostly related to biliary/bleeding events, and were twice higher after right hepatectomy. The incidence of postoperative liver failure was low. Within 3-month follow-up, benchmark values for overall complication were ≤31 %, for minor/major complications ≤23% and ≤9%, respectively, and a CCI ≤33 in LDs with complications. Centers having performed ≥100 hepatectomies had significantly lower rates for overall (10.2% vs 35.9%, P < 0.001) and major (3% vs 12.1%, P < 0.001) complications and overall CCI (2.1 vs 8.5, P < 0.001). Conclusions: The thorough outcome analysis of healthy LDs may serve as a reference for evaluating surgical performance in patients undergoing major liver resection across centers and different patient populations. Further benchmark studies are needed to develop risk-adjusted comparisons of surgical outcomes.

Original languageEnglish (US)
Pages (from-to)492-499
Number of pages8
JournalAnnals of Surgery
Volume264
Issue number3
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Benchmarking
Living Donors
Hepatectomy
Liver
Liver Failure
Morbidity
Blood Transfusion
Length of Stay
Reference Values
Hemorrhage
Safety
Incidence
Population

Keywords

  • Comprehensive complication index
  • Left hemi-hepatectomy
  • Living donor
  • Right hemi-hepatectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Rössler, F., Sapisochin, G., Song, G. W., Lin, Y. H., Simpson, M. A., Hasegawa, K., ... Clavien, P. A. (2016). Defining benchmarks for major liver surgery: A multicenter analysis of 5202 living liver donors. Annals of Surgery, 264(3), 492-499. https://doi.org/10.1097/SLA.0000000000001849

Defining benchmarks for major liver surgery : A multicenter analysis of 5202 living liver donors. / Rössler, Fabian; Sapisochin, Gonzalo; Song, Gi Won; Lin, Yu Hung; Simpson, Mary Ann; Hasegawa, Kiyoshi; Laurenzi, Andrea; Cabús, Santiago Sánchez; Nunez, Milton Inostroza; Gatti, Andrea; Beltrame, Magali Chahdi; Slankamenac, Ksenija; Greig, Paul D.; Lee, Sung Gyu; Chen, Chao Long; Grant, David R.; Pomfret, Elizabeth A.; Kokudo, Norihiro; Cherqui, Daniel; Olthoff, Kim M.; Shaked, Abraham; García-Valdecasas, Juan Carlos; Lerut, Jan; Troisi, Roberto I.; De Santibanes, Martin; Petrowsky, Henrik; Puhan, Milo A.; Clavien, Pierre Alain.

In: Annals of Surgery, Vol. 264, No. 3, 01.09.2016, p. 492-499.

Research output: Contribution to journalArticle

Rössler, F, Sapisochin, G, Song, GW, Lin, YH, Simpson, MA, Hasegawa, K, Laurenzi, A, Cabús, SS, Nunez, MI, Gatti, A, Beltrame, MC, Slankamenac, K, Greig, PD, Lee, SG, Chen, CL, Grant, DR, Pomfret, EA, Kokudo, N, Cherqui, D, Olthoff, KM, Shaked, A, García-Valdecasas, JC, Lerut, J, Troisi, RI, De Santibanes, M, Petrowsky, H, Puhan, MA & Clavien, PA 2016, 'Defining benchmarks for major liver surgery: A multicenter analysis of 5202 living liver donors', Annals of Surgery, vol. 264, no. 3, pp. 492-499. https://doi.org/10.1097/SLA.0000000000001849
Rössler F, Sapisochin G, Song GW, Lin YH, Simpson MA, Hasegawa K et al. Defining benchmarks for major liver surgery: A multicenter analysis of 5202 living liver donors. Annals of Surgery. 2016 Sep 1;264(3):492-499. https://doi.org/10.1097/SLA.0000000000001849
Rössler, Fabian ; Sapisochin, Gonzalo ; Song, Gi Won ; Lin, Yu Hung ; Simpson, Mary Ann ; Hasegawa, Kiyoshi ; Laurenzi, Andrea ; Cabús, Santiago Sánchez ; Nunez, Milton Inostroza ; Gatti, Andrea ; Beltrame, Magali Chahdi ; Slankamenac, Ksenija ; Greig, Paul D. ; Lee, Sung Gyu ; Chen, Chao Long ; Grant, David R. ; Pomfret, Elizabeth A. ; Kokudo, Norihiro ; Cherqui, Daniel ; Olthoff, Kim M. ; Shaked, Abraham ; García-Valdecasas, Juan Carlos ; Lerut, Jan ; Troisi, Roberto I. ; De Santibanes, Martin ; Petrowsky, Henrik ; Puhan, Milo A. ; Clavien, Pierre Alain. / Defining benchmarks for major liver surgery : A multicenter analysis of 5202 living liver donors. In: Annals of Surgery. 2016 ; Vol. 264, No. 3. pp. 492-499.
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abstract = "Objective: To measure and define the best achievable outcome after major hepatectomy. Background: No reference values are available on outcomes after major hepatectomies. Analysis in living liver donors, with safety as the highest priority, offers the opportunity to define outcome benchmarks as the best possible results. Methods: Outcome analyses of 5202 hemi-hepatectomies from living donors (LDs) from 12 high-volume centers worldwide were performed for a 10-year period. Endpoints, calculated at discharge, 3 and 6 months postoperatively, included postoperative morbidity measured by the Clavien-Dindo classification, the Comprehensive Complication Index (CCI), and liver failure according to different definitions. Benchmark values were defined as the 75th percentile of median morbidity values to represent the best achievable results at 3 month postoperatively. Results: Patients were young (34 ± [9] years), predominantly male (65{\%}) and healthy. Surgery lasted 7 ± [2] hours; 2{\%} needed blood transfusions. Mean hospital stay was 11.7 ± [5] days. 12{\%} of patients developed at least 1 complication, of which 3.8{\%} were major events (≥grade III, including 1 death), mostly related to biliary/bleeding events, and were twice higher after right hepatectomy. The incidence of postoperative liver failure was low. Within 3-month follow-up, benchmark values for overall complication were ≤31 {\%}, for minor/major complications ≤23{\%} and ≤9{\%}, respectively, and a CCI ≤33 in LDs with complications. Centers having performed ≥100 hepatectomies had significantly lower rates for overall (10.2{\%} vs 35.9{\%}, P < 0.001) and major (3{\%} vs 12.1{\%}, P < 0.001) complications and overall CCI (2.1 vs 8.5, P < 0.001). Conclusions: The thorough outcome analysis of healthy LDs may serve as a reference for evaluating surgical performance in patients undergoing major liver resection across centers and different patient populations. Further benchmark studies are needed to develop risk-adjusted comparisons of surgical outcomes.",
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T1 - Defining benchmarks for major liver surgery

T2 - A multicenter analysis of 5202 living liver donors

AU - Rössler, Fabian

AU - Sapisochin, Gonzalo

AU - Song, Gi Won

AU - Lin, Yu Hung

AU - Simpson, Mary Ann

AU - Hasegawa, Kiyoshi

AU - Laurenzi, Andrea

AU - Cabús, Santiago Sánchez

AU - Nunez, Milton Inostroza

AU - Gatti, Andrea

AU - Beltrame, Magali Chahdi

AU - Slankamenac, Ksenija

AU - Greig, Paul D.

AU - Lee, Sung Gyu

AU - Chen, Chao Long

AU - Grant, David R.

AU - Pomfret, Elizabeth A.

AU - Kokudo, Norihiro

AU - Cherqui, Daniel

AU - Olthoff, Kim M.

AU - Shaked, Abraham

AU - García-Valdecasas, Juan Carlos

AU - Lerut, Jan

AU - Troisi, Roberto I.

AU - De Santibanes, Martin

AU - Petrowsky, Henrik

AU - Puhan, Milo A.

AU - Clavien, Pierre Alain

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N2 - Objective: To measure and define the best achievable outcome after major hepatectomy. Background: No reference values are available on outcomes after major hepatectomies. Analysis in living liver donors, with safety as the highest priority, offers the opportunity to define outcome benchmarks as the best possible results. Methods: Outcome analyses of 5202 hemi-hepatectomies from living donors (LDs) from 12 high-volume centers worldwide were performed for a 10-year period. Endpoints, calculated at discharge, 3 and 6 months postoperatively, included postoperative morbidity measured by the Clavien-Dindo classification, the Comprehensive Complication Index (CCI), and liver failure according to different definitions. Benchmark values were defined as the 75th percentile of median morbidity values to represent the best achievable results at 3 month postoperatively. Results: Patients were young (34 ± [9] years), predominantly male (65%) and healthy. Surgery lasted 7 ± [2] hours; 2% needed blood transfusions. Mean hospital stay was 11.7 ± [5] days. 12% of patients developed at least 1 complication, of which 3.8% were major events (≥grade III, including 1 death), mostly related to biliary/bleeding events, and were twice higher after right hepatectomy. The incidence of postoperative liver failure was low. Within 3-month follow-up, benchmark values for overall complication were ≤31 %, for minor/major complications ≤23% and ≤9%, respectively, and a CCI ≤33 in LDs with complications. Centers having performed ≥100 hepatectomies had significantly lower rates for overall (10.2% vs 35.9%, P < 0.001) and major (3% vs 12.1%, P < 0.001) complications and overall CCI (2.1 vs 8.5, P < 0.001). Conclusions: The thorough outcome analysis of healthy LDs may serve as a reference for evaluating surgical performance in patients undergoing major liver resection across centers and different patient populations. Further benchmark studies are needed to develop risk-adjusted comparisons of surgical outcomes.

AB - Objective: To measure and define the best achievable outcome after major hepatectomy. Background: No reference values are available on outcomes after major hepatectomies. Analysis in living liver donors, with safety as the highest priority, offers the opportunity to define outcome benchmarks as the best possible results. Methods: Outcome analyses of 5202 hemi-hepatectomies from living donors (LDs) from 12 high-volume centers worldwide were performed for a 10-year period. Endpoints, calculated at discharge, 3 and 6 months postoperatively, included postoperative morbidity measured by the Clavien-Dindo classification, the Comprehensive Complication Index (CCI), and liver failure according to different definitions. Benchmark values were defined as the 75th percentile of median morbidity values to represent the best achievable results at 3 month postoperatively. Results: Patients were young (34 ± [9] years), predominantly male (65%) and healthy. Surgery lasted 7 ± [2] hours; 2% needed blood transfusions. Mean hospital stay was 11.7 ± [5] days. 12% of patients developed at least 1 complication, of which 3.8% were major events (≥grade III, including 1 death), mostly related to biliary/bleeding events, and were twice higher after right hepatectomy. The incidence of postoperative liver failure was low. Within 3-month follow-up, benchmark values for overall complication were ≤31 %, for minor/major complications ≤23% and ≤9%, respectively, and a CCI ≤33 in LDs with complications. Centers having performed ≥100 hepatectomies had significantly lower rates for overall (10.2% vs 35.9%, P < 0.001) and major (3% vs 12.1%, P < 0.001) complications and overall CCI (2.1 vs 8.5, P < 0.001). Conclusions: The thorough outcome analysis of healthy LDs may serve as a reference for evaluating surgical performance in patients undergoing major liver resection across centers and different patient populations. Further benchmark studies are needed to develop risk-adjusted comparisons of surgical outcomes.

KW - Comprehensive complication index

KW - Left hemi-hepatectomy

KW - Living donor

KW - Right hemi-hepatectomy

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