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.

Defining Textbook Outcome in liver surgery and assessment of hospital variation: A nationwide population-based study

“…The Dutch Hepato Biliary Audit (DHBA) is a mandatory registry assessing the Dutch quality of liver surgery or thermal ablation using quality indicators [2]. Using DHBA-data, practice variation in treatment modalities is described previously [3,4].…”

Nationwide oncological networks for resection of colorectal liver metastases in the Netherlands: Differences and postoperative outcomes

“…The main objective of these oncological networks is to decrease variation in preoperative workup and treatment for CRLM which has been described in the Netherlands on a hospital level [7,10,11]. This variation is attributed to differences in patient demographics and disease burden (i.e.…”

The Role of Biomarkers in the Management of Colorectal Liver Metastases

“…The size, number of lesions, and proximity to vascular structures determine resectability, and margin-negative resection is an important factor associated with long-term survival. Furthermore, lesion size, depth from the periphery, and vessel proximity inform combined surgical/ablation approaches to provide definitive management and spare liver parenchyma in the case that future hepatectomy may be needed to clear recurrent disease [ 16 , 17 ]. Second, morphology-based scoring systems demonstrate a prognostic discriminatory ability for long-term survival outcomes ( Table 1 ) [ 18 , 19 , 20 , 21 ].…”