Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases. (2024)

Affiliation

• Elfrink AKE; Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: a.elfrink@dica.nl.
• van Zwet EW; Department of Biomedical Data Sciences, LUMC, Leiden, the Netherlands.
• Swijnenburg RJ; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
• den Dulk M; Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
• van den Boezem PB; Department of Surgery, Radboud Medical Center, Nijmegen, the Netherlands.
• Mieog JSD; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
• Te Riele WW; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
• Patijn GA; Department of Surgery, Isala, Zwolle, the Netherlands.
• Leclercq WKG; Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands.
• Lips DJ; Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
• Rijken AM; Department of Surgery, Amphia Hospital, Breda, the Netherlands.
• Verhoef C; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
• Kuhlmann KFD; Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands.
• Buis CI; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
• Bosscha K; Department of Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands.
• Belt EJT; Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
• Vermaas M; Department of Surgery, Ijsselland Hospital, Capelle a/d Ijssel, the Netherlands.
• van Heek NT; Department of Surgery, Gelderse Vallei, Ede, the Netherlands.
• Oosterling SJ; Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.
• Torrenga H; Department of Surgery, Deventer Hospital, Deventer, the Netherlands.
• Eker HH; Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
• Consten ECJ; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands.
• Marsman HA; Department of Surgery, OLVG, Amsterdam, the Netherlands.
• Wouters MWJM; Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands.
• Kok NFM; Department of Surgery, Antoni van Leeuwenhoek - Dutch Cancer Institute, Amsterdam, the Netherlands.
• Grünhagen DJ; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
• Klaase JM; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.

ABSTRACT

BACKGROUND:

Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM).

METHODS:

This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019.

RESULTS:

In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p < 0.001), ASA 3 or higher (3.3%-36.3%, p < 0.001), histopathological parenchymal liver disease (0.0%-47.1%, p < 0.001), history of liver resection (8.1%-36.3%, p < 0.001), major liver resection (6.7%-38.0%, p < 0.001) and synchronous metastases (35.5%-62.1%, p < 0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes.

CONCLUSION:

Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM.