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Hospital variation in Textbook Outcomes following curative-intent resection of hepatocellular carcinoma: an international multi-institutional analysis.
HPB ( IF 2.9 ) Pub Date : 2019-12-27 , DOI: 10.1016/j.hpb.2019.12.005
Diamantis I Tsilimigras 1 , Rittal Mehta 1 , Katiuscha Merath 1 , Fabio Bagante 2 , Anghela Z Paredes 1 , Ayesha Farooq 1 , Francesca Ratti 3 , Hugo P Marques 4 , Silvia Silva 4 , Olivier Soubrane 5 , Vincent Lam 6 , George A Poultsides 7 , Irinel Popescu 8 , Razvan Grigorie 8 , Sorin Alexandrescu 8 , Guillaume Martel 9 , Aklile Workneh 9 , Alfredo Guglielmi 10 , Tom Hugh 11 , Luca Aldrighetti 3 , Itaru Endo 12 , Timothy M Pawlik 1
Affiliation  

Background

Composite measures such as “Textbook Outcome” (TO) may be superior to individual quality metrics to assess surgical care and hospital performance. However, the incidence and factors associated with TO after resection of HCC remain poorly defined.

Methods

Hospital variation in the rates of TO, factors associated with achieving a TO and the impact of TO on long-term survival following resection for HCC were examined using an international multi-institutional database.

Results

Among 605 patients who underwent curative-intent resection of HCC, the unadjusted incidence of TO ranged from 50.9% to 77.7%. While achievement of each individual quality metric was relatively high (range, 74.5–98.0%), an overall TO was achieved among only 62.3% (n = 377) of patients. At the hospital level, TO ranged from 54.3% to 72.9%. Patients with BCLC-0 HCC (referent BCLC-B/C; OR: 4.17, 95%CI: 1.62–10.7) and ALBI grade 1 (referent ALBI grade 2/3; OR: 1.49, 95%CI: 1.06–2.11) had higher odds of achieving a TO. On multivariable analysis, TO was associated with improved overall survival (HR: 0.60, 95% CI: 0.42–0.85).

Conclusion

Roughly 6 in 10 patients achieved a TO following resection for HCC. When achieved, TO was associated with better long-term outcomes. TO is a simple composite measure of both short- and long-term outcomes among patients undergoing resection for HCC.



中文翻译:

肝细胞癌根治性切除术后教科书结果的医院差异:一项国际多机构分析。

背景

在评估外科护理和医院绩效方面,诸如“教科书结果”(TO) 之类的综合指标可能优于个人质量指标。然而,HCC 切除后 TO 的发生率和相关因素仍不明确。

方法

使用国际多机构数据库检查了 TO 发生率的医院变异、与实现 TO 相关的因素以及 TO 对 HCC 切除术后长期生存的影响。

结果

在 605 名接受 HCC 根治性切除术的患者中,未调整的 TO 发生率为 50.9% 至 77.7%。虽然每个个体质量指标的实现相对较高(范围,74.5-98.0%),但只有 62.3%(n = 377)的患者实现了总体 TO。在医院层面,TO 介于 54.3% 至 72.9% 之间。BCLC-0 HCC(参考 BCLC-B/C;OR:4.17,95%CI:1.62–10.7)和 ALBI 1 级(参考 ALBI 2/3 级;OR:1.49,95%CI:1.06–2.11)的患者获得 TO 的几率更高。在多变量分析中,TO 与总生存期改善相关(HR:0.60,95% CI:0.42–0.85)。

结论

大约每 10 名患者中就有 6 名在 HCC 切除术后达到 TO。实现后,TO 与更好的长期结果相关。TO 是对接受 HCC 切除术的患者的短期和长期结果的简单综合测量。

更新日期:2019-12-27
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