Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study

Elfrink, A.K.E.; Olthof, P.B.; Swijnenburg, R.J.; Dulk, M. den; Boer, M.T. de; Mieog, J.S.D.; Hagendoorn, J.; Kazemier, G.; Boezem, P.B. van den; Rijken, A.M.; Liem, M.S.L.; Leclercq, W.K.G.; Kuhlmann, K.F.D.; Marsman, H.A.; Ijzermans, J.N.M.; Duijvendijk, P. van; Erdmann, J.I.; Kok, N.F.M.; Grunhagen, D.J.; Klaase, J.M.; Dutch Hepato Biliary Audit Grp; Collaborating Liver Surg

doi:doi:10.1016/j.hpb.2021.04.020

Background: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery.Methods: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade >= 3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable lo-gistic regression.Results: Of 4961 patients included, 3707 (74.4%) underwent liver resection for colorectal liver me-tastases, 379 (7.6%) for other metastases, 526 (10.6%) for hepatocellular carcinoma and 349 (7.0%) for biliary cancer. Thirty-day major morbidity was 11.5%. Overall mortality was 2.3%. FTR was 19.1%. Age 65-80 (aOR: 2.86, CI:1.01-12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66-4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81-9.22, p < 0.001), biliary cancer (aOR...Show moreBackground: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery.Methods: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade >= 3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable lo-gistic regression.Results: Of 4961 patients included, 3707 (74.4%) underwent liver resection for colorectal liver me-tastases, 379 (7.6%) for other metastases, 526 (10.6%) for hepatocellular carcinoma and 349 (7.0%) for biliary cancer. Thirty-day major morbidity was 11.5%. Overall mortality was 2.3%. FTR was 19.1%. Age 65-80 (aOR: 2.86, CI:1.01-12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66-4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81-9.22, p < 0.001), biliary cancer (aOR:3.47, CI: 1.73-6.96, p < 0.001), and major resection (aOR:6.46, CI: 3.91-10.9, p < 0.001) were associated with FTR. Postoperative liver failure (aOR: 26.9, CI: 14.6-51.2, p < 0.001), cardiac (aOR: 2.62, CI: 1.27-5.29, p = 0.008) and thromboembolic complications (aOR: 2.49, CI: 1.16-5.22, p = 0.017) were associated with FTR. After case-mix correction, no hospital variation in FTR was observed.Conclusion: FTR is influenced by patient demographics, disease and procedural burden. Prevention of postoperative liver failure, cardiac and thromboembolic complications could decrease FTR.Show less

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Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study