Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

Simone Famularo; Nadia Russolillo; Matteo Donadon; Federica Cipriani; Francesco Ardito; Pasquale Perri; Alessandro Giani; Francesca De Stefano; Quirino Lai; Sarah Molfino; Matteo Zanello; Maurizio Iaria; Giuliano La Barba; Enrico Pinotti; Paola Germani; Simone Conci; Cecilia Ferrari; Luca Fumagalli; Maurizio Romano; Adelmo Antonucci; Giuseppe Zimmitti; Albert Troci; Antonio Floridi; Valentina Ferraro; Stefan Patauner; Antonio Frena; Riccardo Memeo; Michele Crespi; Mohammed A. Hilal; Giacomo Zanus; Marco Chiarelli; Andrea Percivale; Andrea Ruzzenente; Paola Tarchi; Mauro Zago; Giorgio Ercolani; Raffaele Dalla Valle; Elio Jovine; Gian Luca Baiocchi; Massimo Rossi; Marcello Maestri; Fabrizio Romano; Gian Luca Grazi; Felice Giuliante; Luca Aldrighetti; Alessandro Ferrero; Guido Torzilli; Guido Costa; Flavio Milana; Federico Fazio; Francesca Ratti; Francesco Razionale; Valerio De Peppo; Francesca Carissimi; Giorgio M. Paolo Graziano; Zoe L. Laurerio; Mario Giuffrida; Alessandro Cucchetti; Mauro Montuori; Davide Cosola; Pio Corleone; Giovanni Lazzari; Angelo Franceschi; Pietro Calcagno; Luca Salvador; Alberto Manzoni; Luca Pennacchi; Annarita Libia; Francesca Notte; Davide P. Bernasconi; Silvia Mori; Davide Gaudesi

doi:10.1016/j.hpb.2022.02.008

Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

Simone Famularo, Nadia Russolillo, Matteo Donadon, Federica Cipriani, Francesco Ardito, Pasquale Perri, Alessandro Giani, Francesca De Stefano, Quirino Lai, Sarah Molfino, Matteo Zanello, Maurizio Iaria, Giuliano La Barba, Enrico Pinotti, Paola Germani, Simone Conci, Cecilia Ferrari, Luca Fumagalli, Maurizio Romano, Adelmo AntonucciGiuseppe Zimmitti, Albert Troci, Antonio Floridi, Valentina Ferraro, Stefan Patauner, Antonio Frena, Riccardo Memeo, Michele Crespi, Mohammed A. Hilal, Giacomo Zanus, Marco Chiarelli, Andrea Percivale, Andrea Ruzzenente, Paola Tarchi, Mauro Zago, Giorgio Ercolani, Raffaele Dalla Valle, Elio Jovine, Gian Luca Baiocchi, Massimo Rossi, Marcello Maestri, Fabrizio Romano, Gian Luca Grazi, Felice Giuliante, Luca Aldrighetti, Alessandro Ferrero, Guido Torzilli, Guido Costa, Flavio Milana, Federico Fazio, Francesca Ratti, Francesco Razionale, Valerio De Peppo, Francesca Carissimi, Giorgio M. Paolo Graziano, Zoe L. Laurerio, Mario Giuffrida, Alessandro Cucchetti, Mauro Montuori, Davide Cosola, Pio Corleone, Giovanni Lazzari, Angelo Franceschi, Pietro Calcagno, Luca Salvador, Alberto Manzoni, Luca Pennacchi, Annarita Libia, Francesca Notte, Davide P. Bernasconi, Silvia Mori, Davide Gaudesi

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined. Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3). Results: A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups). Conclusion: We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.

Original language	English
Pages (from-to)	N/A-N/A
Journal	HPB
Volume	2022
DOIs	https://doi.org/10.1016/j.hpb.2022.02.008
Publication status	Published - 2022

Keywords

Benchmarking
cirrhotic patients
hepatocellular carcinoma
liver surgery

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10.1016/j.hpb.2022.02.008

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Famularo, S., Russolillo, N., Donadon, M., Cipriani, F., Ardito, F., Perri, P., Giani, A., De Stefano, F., Lai, Q., Molfino, S., Zanello, M., Iaria, M., La Barba, G., Pinotti, E., Germani, P., Conci, S., Ferrari, C., Fumagalli, L., Romano, M., ... Gaudesi, D. (2022). Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort. HPB, 2022, N/A-N/A. https://doi.org/10.1016/j.hpb.2022.02.008

@article{41f8f42964cd452f93e601a39c46b9d1,

title = "Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort",

abstract = "Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined. Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3). Results: A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups). Conclusion: We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.",

keywords = "Benchmarking, cirrhotic patients, hepatocellular carcinoma, liver surgery, Benchmarking, cirrhotic patients, hepatocellular carcinoma, liver surgery",

author = "Simone Famularo and Nadia Russolillo and Matteo Donadon and Federica Cipriani and Francesco Ardito and Pasquale Perri and Alessandro Giani and {De Stefano}, Francesca and Quirino Lai and Sarah Molfino and Matteo Zanello and Maurizio Iaria and {La Barba}, Giuliano and Enrico Pinotti and Paola Germani and Simone Conci and Cecilia Ferrari and Luca Fumagalli and Maurizio Romano and Adelmo Antonucci and Giuseppe Zimmitti and Albert Troci and Antonio Floridi and Valentina Ferraro and Stefan Patauner and Antonio Frena and Riccardo Memeo and Michele Crespi and Hilal, {Mohammed A.} and Giacomo Zanus and Marco Chiarelli and Andrea Percivale and Andrea Ruzzenente and Paola Tarchi and Mauro Zago and Giorgio Ercolani and {Dalla Valle}, Raffaele and Elio Jovine and Baiocchi, {Gian Luca} and Massimo Rossi and Marcello Maestri and Fabrizio Romano and Grazi, {Gian Luca} and Felice Giuliante and Luca Aldrighetti and Alessandro Ferrero and Guido Torzilli and Guido Costa and Flavio Milana and Federico Fazio and Francesca Ratti and Francesco Razionale and {De Peppo}, Valerio and Francesca Carissimi and {Paolo Graziano}, {Giorgio M.} and Laurerio, {Zoe L.} and Mario Giuffrida and Alessandro Cucchetti and Mauro Montuori and Davide Cosola and Pio Corleone and Giovanni Lazzari and Angelo Franceschi and Pietro Calcagno and Luca Salvador and Alberto Manzoni and Luca Pennacchi and Annarita Libia and Francesca Notte and Bernasconi, {Davide P.} and Silvia Mori and Davide Gaudesi",

year = "2022",

doi = "10.1016/j.hpb.2022.02.008",

language = "English",

volume = "2022",

pages = "N/A--N/A",

journal = "HPB",

issn = "1365-182X",

publisher = "Elsevier B.V.",

}

Famularo, S, Russolillo, N, Donadon, M, Cipriani, F, Ardito, F, Perri, P, Giani, A, De Stefano, F, Lai, Q, Molfino, S, Zanello, M, Iaria, M, La Barba, G, Pinotti, E, Germani, P, Conci, S, Ferrari, C, Fumagalli, L, Romano, M, Antonucci, A, Zimmitti, G, Troci, A, Floridi, A, Ferraro, V, Patauner, S, Frena, A, Memeo, R, Crespi, M, Hilal, MA, Zanus, G, Chiarelli, M, Percivale, A, Ruzzenente, A, Tarchi, P, Zago, M, Ercolani, G, Dalla Valle, R, Jovine, E, Baiocchi, GL, Rossi, M, Maestri, M, Romano, F, Grazi, GL, Giuliante, F, Aldrighetti, L, Ferrero, A, Torzilli, G, Costa, G, Milana, F, Fazio, F, Ratti, F, Razionale, F, De Peppo, V, Carissimi, F, Paolo Graziano, GM, Laurerio, ZL, Giuffrida, M, Cucchetti, A, Montuori, M, Cosola, D, Corleone, P, Lazzari, G, Franceschi, A, Calcagno, P, Salvador, L, Manzoni, A, Pennacchi, L, Libia, A, Notte, F, Bernasconi, DP, Mori, S & Gaudesi, D 2022, 'Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort', HPB, vol. 2022, pp. N/A-N/A. https://doi.org/10.1016/j.hpb.2022.02.008

TY - JOUR

T1 - Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

AU - Famularo, Simone

AU - Russolillo, Nadia

AU - Donadon, Matteo

AU - Cipriani, Federica

AU - Ardito, Francesco

AU - Perri, Pasquale

AU - Giani, Alessandro

AU - De Stefano, Francesca

AU - Lai, Quirino

AU - Molfino, Sarah

AU - Zanello, Matteo

AU - Iaria, Maurizio

AU - La Barba, Giuliano

AU - Pinotti, Enrico

AU - Germani, Paola

AU - Conci, Simone

AU - Ferrari, Cecilia

AU - Fumagalli, Luca

AU - Romano, Maurizio

AU - Antonucci, Adelmo

AU - Zimmitti, Giuseppe

AU - Troci, Albert

AU - Floridi, Antonio

AU - Ferraro, Valentina

AU - Patauner, Stefan

AU - Frena, Antonio

AU - Memeo, Riccardo

AU - Crespi, Michele

AU - Hilal, Mohammed A.

AU - Zanus, Giacomo

AU - Chiarelli, Marco

AU - Percivale, Andrea

AU - Ruzzenente, Andrea

AU - Tarchi, Paola

AU - Zago, Mauro

AU - Ercolani, Giorgio

AU - Dalla Valle, Raffaele

AU - Jovine, Elio

AU - Baiocchi, Gian Luca

AU - Rossi, Massimo

AU - Maestri, Marcello

AU - Romano, Fabrizio

AU - Grazi, Gian Luca

AU - Giuliante, Felice

AU - Aldrighetti, Luca

AU - Ferrero, Alessandro

AU - Torzilli, Guido

AU - Costa, Guido

AU - Milana, Flavio

AU - Fazio, Federico

AU - Ratti, Francesca

AU - Razionale, Francesco

AU - De Peppo, Valerio

AU - Carissimi, Francesca

AU - Paolo Graziano, Giorgio M.

AU - Laurerio, Zoe L.

AU - Giuffrida, Mario

AU - Cucchetti, Alessandro

AU - Montuori, Mauro

AU - Cosola, Davide

AU - Corleone, Pio

AU - Lazzari, Giovanni

AU - Franceschi, Angelo

AU - Calcagno, Pietro

AU - Salvador, Luca

AU - Manzoni, Alberto

AU - Pennacchi, Luca

AU - Libia, Annarita

AU - Notte, Francesca

AU - Bernasconi, Davide P.

AU - Mori, Silvia

AU - Gaudesi, Davide

PY - 2022

Y1 - 2022

N2 - Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined. Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3). Results: A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups). Conclusion: We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.

AB - Background: Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined. Methods: Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3). Results: A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups). Conclusion: We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.

KW - Benchmarking

KW - cirrhotic patients

KW - hepatocellular carcinoma

KW - liver surgery

KW - Benchmarking

KW - cirrhotic patients

KW - hepatocellular carcinoma

KW - liver surgery

UR - http://hdl.handle.net/10807/199165

U2 - 10.1016/j.hpb.2022.02.008

DO - 10.1016/j.hpb.2022.02.008

M3 - Article

SN - 1365-182X

VL - 2022

SP - N/A-N/A

JO - HPB

JF - HPB

ER -

Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

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Keywords

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