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 language | English (US) |
|---|---|
| Pages (from-to) | 492-499 |
| Number of pages | 8 |
| Journal | Annals of Surgery |
| Volume | 264 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2016 |
| Externally published | Yes |
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Keywords
- Comprehensive complication index
- Left hemi-hepatectomy
- Living donor
- Right hemi-hepatectomy
ASJC Scopus subject areas
- Surgery
Cite this
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 journal › Article
}
TY - JOUR
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
PY - 2016/9/1
Y1 - 2016/9/1
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
UR - http://www.scopus.com/inward/record.url?scp=84978655501&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84978655501&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000001849
DO - 10.1097/SLA.0000000000001849
M3 - Article
C2 - 27433909
AN - SCOPUS:84978655501
VL - 264
SP - 492
EP - 499
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 3
ER -