Factors Related to Textbook Outcome in Laparoscopic Liver Resections: a Single Western Centre Analysis

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2022 Aug 12

PMID 35962214

Authors

Andrea Ruzzenente

Edoardo Poletto

Simone Conci

Tommaso Campagnaro

Bernardo Dalla Valle

Mario De Bellis

Alfredo Guglielmi

Affiliations

Soon will be listed here.

Abstract

Introduction: The selection of the most informative quality of care indicator for laparoscopic liver surgery (LLS) is still debated; among those proposed, textbook outcome (TO) seems to provide a compositive measure of the outcomes of surgery. The aim of this study was to investigate the factors related with the TO in a cohort of patients who underwent LLS.

Methods: Patients who underwent LLS from 2014 to 2021 were included. TO for LLS (TOLLS) was defined as: R0 resection, absence of intraoperative incidents, severe complications, reintervention, 30-day readmission and in-hospital mortality. When also considering no prolonged length of hospital stay (LOS), the outcome was called TOLLS+.

Results: Four hundred twenty-one patients were included; TOLLS was achieved in 80.5%, TOLLS+ in 60.8% cases. R0 resection was obtained in 90.2% cases, intraoperative incidents occurred in 7.8%, severe complications in 5.0%, reintervention in 0.7%, readmission in 1.4% and in-hospital mortality in 0.2%. 32.5% of patients showed prolonged LOS. After univariate and multivariate analysis, factors influencing TOLLS were age (OR 0.967; p=0.003), concomitant surgery (OR 0.380; p=0.003), operative time (OR 0.996; p=0.008) and blood loss (OR 0.241; p<0.001); factors influencing TOLLS+ were ASA-score (OR 0.533; p=0.008), tumour histology (OR 0.421; p=0.021), concomitant surgery (OR 0.293; p<0.001), operative time (OR 0.997; p=0.016) and blood loss (OR 0.361; p=0.003).

Conclusions: TOLLS can be achieved in most patients undergoing LLR, and it seems to be influenced mostly by surgery-related factors; conversely, TOLLS+ is achieved less frequently and seems to be influenced also by patient- and tumour-related factors.

Citing Articles

Realizing Textbook Outcomes Following Liver Resection for Hepatic Neoplasms with Development and Validation of a Predictive Nomogram.

Gundavda K, Patkar S, Kannan S, Varty G, Nandy K, Shah T Ann Surg Oncol. 2024; 31(12):7870-7881.

PMID: 39103690 PMC: 11466989. DOI: 10.1245/s10434-024-15983-6.

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