| Contributors: |
Hobeika, C.; Fuks, D.; Cauchy, F.; Goumard, C.; Gayet, B.; Laurent, A.; Soubrane, O.; Salame, E.; Cherqui, D.; Regimbeau, J. -M.; Mabrut, J. -Y.; Scatton, O.; Vibert, E.; Nomi, T.; Oudafal, N.; Kawai, T.; Komatsu, S.; Okumura, S.; Petrucciani, N.; Bucur, P.; Barbier, L.; Trechot, B.; Nunez, J.; Tedeschi, M.; Allard, M. -A.; Golse, N.; Ciacio, O.; Pittau, G.; Sa Cunha, A.; Adam, R.; Laurent, C.; Chiche, L.; Leourier, P.; Rebibo, L.; Ferre, L.; Souche, F. R.; Chauvat, J.; Fabre, J. -M.; Jehaes, F.; Mohkam, K.; Lesurtel, M.; Ducerf, C.; Hor, T.; Paye, F.; Balladur, P.; Suc, B.; Muscari, F.; Millet, G.; El Amrani, M.; Ratajczak, C.; Lecolle, K.; Boleslawski, E.; Truant, S.; Pruvot, F. -R.; Kianmanesh, A. -R.; Codjia, T.; Schwarz, L.; Girard, E.; Abba, J.; Letoublon, C.; Chirica, M.; Carmelo, A.; VanBrugghe, C.; Cherkaoui, Z.; Unterteiner, X.; Memeo, R.; Pessaux, P.; Buc, E.; Lermite, E.; Barbieux, J.; Bougard, M.; Marchese, U.; Ewald, J.; Turini, O.; Thobie, A.; Menahem, B.; Mulliri, A.; Lubrano, J.; Zemour, J.; Fagot, H.; Passot, G.; Gregoire, E.; Hardwigsen, J.; le Treut, Y. -P.; Patrice, D. |
| Description: |
Background & Aims: Herein, we aimed to establish benchmark values – based on a composite indicator of healthcare quality – for the performance of laparoscopic left lateral sectionectomy (LLLS) and laparoscopic right hepatectomy (LRH) using data from expert centers. Methods: Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all 6 of the following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off laparoscopic liver resection (LLR) volume by center was associated with TO on multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers. Results: Among 4,400 LLRs performed in 29 centers, 855 patients who underwent LLLS and 488 who underwent LRH were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (odds ratio [OR] 2.45; bootstrap 95% CI 1.65–3.69; p = 0.001) and 35 LLR/year (OR 2.55; bootstrap 95% CI 1.34–5.63; p = 0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers for LLLS and 6 centers for LRH, including 516 and 346 patients undergoing LLLS/LRH respectively, reached these cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%, respectively. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%, respectively. Conclusions: This study provides an up-to-date reference on the benchmark performance of LLLS and LRH in expert centers. Lay summary: In a nationwide French survey of laparoscopic liver resection, expert centers were defined according to the completion ... |