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Textbook outcomes for liver resection: can a medium sized centre have acceptable outcomes?
Jared Mclauchlan1, Kirsten de Burlet1, Maria Nonis1
1Department of General Surgery, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand.
ANZ Journal of Surgery
|October 3, 2023
Summary
Textbook outcome (TO) rates in liver resection at a New Zealand hospital were comparable to international benchmarks. Continuous quality monitoring using CuSum analysis identified performance fluctuations, enabling surgical units to improve outcomes.
Area of Science:
- Hepatobiliary surgery
- Surgical outcomes research
- Quality improvement in healthcare
Background:
- Textbook outcome (TO) is a validated metric for assessing surgical results.
- Previous studies utilized TO to benchmark liver surgery performance internationally.
- This study evaluated TO rates and performance monitoring in liver resections at a single institution.
Purpose of the Study:
- To determine Textbook Outcome (TO) rates following liver resection.
- To implement CuSum analysis for monitoring surgical performance quality over time.
- To assess TO for colorectal cancer liver metastases (CRCLM) specifically.
Main Methods:
- Retrospective analysis of 478 liver resections (benign and malignant) from 2005-2022.
- TO defined by absence of intraoperative incidents, major complications, re-admission, mortality, positive margins, or organ failure.
- Sequential CuSum analysis applied to monitor TO for CRCLM cases.
Main Results:
- Overall TO rate was 74% (82% benign, 73% CRCLM, 74% other malignancy).
- No significant difference in TO rates across pathology types (P=0.405).
- CuSum analysis revealed a temporary performance dip after 60 patients, followed by a return to baseline.
Conclusions:
- Liver resection TO rates at this New Zealand center are comparable to international standards.
- CuSum analysis is effective for monitoring surgical performance using binary TO data.
- Process control techniques facilitate continuous quality improvement in surgical departments.
