Risk-adjusted benchmarks in laparoscopic liver surgery in a national cohort

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Assessing best achievable outcomes in laparoscopic liver resection (LLR) is crucial.
• Risk adjustment based on surgical technical difficulty is needed for accurate outcome evaluation.
• Utilizing national registry data provides a robust foundation for such assessments.

Purpose of the Study:

• To establish benchmarks for laparoscopic liver resection (LLR) outcomes.
• To adjust these benchmarks based on surgical technical difficulty.
• To identify independent risk factors influencing morbidity in LLR.

Main Methods:

• Utilized data from the Italian Group of Minimally Invasive Liver Surgery registry (November 2014–March 2018).
• Calculated Achievable Benchmark of Care (ABC™) for overall and major morbidity.
• Categorized LLRs into difficulty clusters (I, II, III) using Kawaguchi classification and performed multivariable analysis to identify risk factors.

Main Results:

• Achievable Benchmark of Care (ABC™) for overall morbidity ranged from 7.8% (Group I) to 26.4% (Group III), and for major morbidity from 1.4% to 5.7%.
• Independent risk factors for increased overall morbidity included multiple LLRs (OR 1.35) and simultaneous intestinal resection (OR 3.76).
• Cirrhosis (OR 1.83) and intestinal resection (OR 4.61) were significant risk factors for overall and major morbidity, respectively.

Conclusions:

• Established morbidity benchmarks for LLR that vary by complexity.
• Highlighted the need to adjust benchmark values for factors such as multiple LLRs, intestinal resection, and cirrhosis.
• Emphasized the importance of risk-adjusted outcome assessment in LLR to reflect true performance.