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A core set of quality performance indicators for HPB procedures: a global consensus for hepatectomy, pancreatectomy,
Braden Woodhouse1, Savio G Barreto2, Kjetil Soreide3
1Department of Oncology, The University of Auckland, Auckland, New Zealand.
Insights
Globally accepted quality performance indicators (QPI) for hepatopancreaticobiliary (HPB) surgery were developed. This core set aims to standardize and improve care for complex HPB procedures worldwide.
Area of Science:
- Hepatopancreaticobiliary (HPB) Surgery
- Surgical Quality Improvement
- Global Health Standards
Background:
- Hepatopancreaticobiliary (HPB) surgery is a critical global surgical discipline.
- Standardized quality metrics are needed to ensure consistent patient outcomes.
- This study aimed to establish internationally recognized procedural quality performance indicators (QPI) for HPB surgery.
Approach:
- A systematic literature review identified existing QPI for major HPB procedures.
- A modified Delphi process involving International Hepatopancreaticobiliary Association (IHPBA) experts refined the indicators.
- Global consensus was achieved through multi-round expert review and final IHPBA membership approval.
Key Points:
- Seven core QPI were agreed upon for hepatectomy, pancreatectomy, and complex biliary surgery, focusing on service availability, team expertise, case volume, pathology, reintervention, complications, and mortality.
- Procedure-specific QPI were also proposed for pancreatectomy, hepatectomy, complex biliary surgery, and cholecystectomy.
- The final QPI set was approved by 102 IHPBA members across 34 countries.
Conclusions:
- This work establishes a core set of internationally agreed-upon QPI for HPB surgery.
- These indicators provide a foundation for global quality assessment and improvement in HPB surgical practice.
- The developed QPI will facilitate benchmarking and drive advancements in patient care for HPB conditions.
Background:
Surgery for hepatopancreaticobiliary (HPB) conditions is performed worldwide. This investigation aimed to develop a set of globally accepted procedural quality performance indicators (QPI) for HPB surgical procedures.
Methods:
A systematic literature review generated a dataset of published QPI for hepatectomy, pancreatectomy, complex biliary surgery and cholecystectomy. Using a modified Delphi process, three rounds were conducted with working groups composed of self-nominating members of the International Hepatopancreaticobiliary Association (IHPBA). The final set of QPI was circulated to the full membership of the IHPBA for review.
Results:
Seven "core" indicators were agreed for hepatectomy, pancreatectomy, and complex biliary surgery (availability of specific services on site, a specialised surgical team with at least two certified HPB surgeons, a satisfactory institutional case volume, synoptic pathology reporting, undertaking of unplanned reintervention procedures within 90 days, the incidence of post-procedure bile leak and Clavien-Dindo grade ≥III complications and 90-day post-procedural mortality). Three further procedure specific QPI were proposed for pancreatectomy, six for hepatectomy and complex biliary surgery. Nine procedure-specific QPIs were proposed for cholecystectomy. The final set of proposed indicators were reviewed and approved by 102 IHPBA members from 34 countries.
Conclusions:
This work presents a core set of internationally agreed QPI for HPB surgery.
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