A Multi-Institutional International Analysis of Textbook Outcomes Among Patients Undergoing Curative-Intent Resection of Intrahepatic Cholangiocarcinoma
IMPORTANCE: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care. OBJECTIVE: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-...
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| Published in | JAMA surgery Vol. 154; no. 6; p. e190571 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Medical Association
01.06.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2168-6254 2168-6262 2168-6262 |
| DOI | 10.1001/jamasurg.2019.0571 |
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| Abstract | IMPORTANCE: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care. OBJECTIVE: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. DESIGN, SETTING, AND PARTICIPANTS: This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018. MAIN OUTCOMES AND MEASURES: Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes. RESULTS: Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P = .03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P = .02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P = .04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P = .049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P = .001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P = .009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763). CONCLUSIONS AND RELEVANCE: In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma. |
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| AbstractList | Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care.
To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma.
This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018.
Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes.
Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P = .03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P = .02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P = .04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P = .049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P = .001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P = .009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763).
In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma. Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care.ImportanceComposite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care.To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma.ObjectiveTo determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma.This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018.Design, Setting, and ParticipantsThis cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018.Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes.Main Outcomes and MeasuresHospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes.Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P = .03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P = .02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P = .04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P = .049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P = .001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P = .009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763).ResultsAmong 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P = .03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P = .02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P = .04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P = .049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P = .001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P = .009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763).In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma.Conclusions and RelevanceIn this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma. IMPORTANCE: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care. OBJECTIVE: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. DESIGN, SETTING, AND PARTICIPANTS: This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018. MAIN OUTCOMES AND MEASURES: Hospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes. RESULTS: Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P = .03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P = .02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P = .04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P = .049), N0 status (OR, 3.89 [95% CI, 1.77-8.54]; P = .001), and no bile duct resection (OR, 2.46 [95% CI, 1.25-4.84]; P = .009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763). CONCLUSIONS AND RELEVANCE: In this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma. This cohort study combines data from 15 hospitals in Asia, North America, Europe, and Australia to determine the incidence of a textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. |
| Author | Maithel, Shishir K Bagante, Fabio Aldrighetti, Luca Guglielmi, Alfredo Bauer, Todd W Itaru, Endo Pawlik, Timothy M Marques, Hugo P Merath, Katiuscha Soubrane, Olivier Pulitano, Carlo Shen, Feng Poultsides, George A Koerkamp, B. Groot Chen, Qinyu Alexandrescu, Sorin Weiss, Matthew J Martel, Guillaume Cloyd, Jordan M |
| AuthorAffiliation | 6 Emory University, Atlanta, Georgia 14 Erasmus University Medical Center, Rotterdam, the Netherlands 15 Yokohama City University, Yokohama, Japan 9 University of Virginia, Charlottesville, Virginia 7 University of Sydney, Sydney, Australia 11 Stanford University, Stanford, California 3 Fundeni Clinical Institute, Bucharest, Romania 13 University of Ottawa, Ontario, Canada 1 The Ohio State University Wexner Medical Center, Columbus 2 University of Verona, Verona, Italy 8 Johns Hopkins Hospital, Baltimore, Maryland 10 Eastern Hepatobiliary Surgery Hospital, Shanghai, China 5 Ospedale San Raffaele, Milan, Italy 12 Beaujon Hospital, Clichy, France 4 Curry Cabral Hospital, Lisbon, Portugal |
| AuthorAffiliation_xml | – name: 13 University of Ottawa, Ontario, Canada – name: 7 University of Sydney, Sydney, Australia – name: 14 Erasmus University Medical Center, Rotterdam, the Netherlands – name: 6 Emory University, Atlanta, Georgia – name: 11 Stanford University, Stanford, California – name: 10 Eastern Hepatobiliary Surgery Hospital, Shanghai, China – name: 15 Yokohama City University, Yokohama, Japan – name: 4 Curry Cabral Hospital, Lisbon, Portugal – name: 5 Ospedale San Raffaele, Milan, Italy – name: 3 Fundeni Clinical Institute, Bucharest, Romania – name: 9 University of Virginia, Charlottesville, Virginia – name: 2 University of Verona, Verona, Italy – name: 12 Beaujon Hospital, Clichy, France – name: 1 The Ohio State University Wexner Medical Center, Columbus – name: 8 Johns Hopkins Hospital, Baltimore, Maryland |
| Author_xml | – sequence: 1 givenname: Katiuscha surname: Merath fullname: Merath, Katiuscha – sequence: 2 givenname: Qinyu surname: Chen fullname: Chen, Qinyu – sequence: 3 givenname: Fabio surname: Bagante fullname: Bagante, Fabio – sequence: 4 givenname: Sorin surname: Alexandrescu fullname: Alexandrescu, Sorin – sequence: 5 givenname: Hugo P surname: Marques fullname: Marques, Hugo P – sequence: 6 givenname: Luca surname: Aldrighetti fullname: Aldrighetti, Luca – sequence: 7 givenname: Shishir K surname: Maithel fullname: Maithel, Shishir K – sequence: 8 givenname: Carlo surname: Pulitano fullname: Pulitano, Carlo – sequence: 9 givenname: Matthew J surname: Weiss fullname: Weiss, Matthew J – sequence: 10 givenname: Todd W surname: Bauer fullname: Bauer, Todd W – sequence: 11 givenname: Feng surname: Shen fullname: Shen, Feng – sequence: 12 givenname: George A surname: Poultsides fullname: Poultsides, George A – sequence: 13 givenname: Olivier surname: Soubrane fullname: Soubrane, Olivier – sequence: 14 givenname: Guillaume surname: Martel fullname: Martel, Guillaume – sequence: 15 givenname: B. Groot surname: Koerkamp fullname: Koerkamp, B. Groot – sequence: 16 givenname: Alfredo surname: Guglielmi fullname: Guglielmi, Alfredo – sequence: 17 givenname: Endo surname: Itaru fullname: Itaru, Endo – sequence: 18 givenname: Jordan M surname: Cloyd fullname: Cloyd, Jordan M – sequence: 19 givenname: Timothy M surname: Pawlik fullname: Pawlik, Timothy M |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31017645$$D View this record in MEDLINE/PubMed |
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| Copyright | Copyright 2019 American Medical Association. All Rights Reserved. |
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| SubjectTerms | Adolescent Adult Age Distribution Aged Aged, 80 and over Asia - epidemiology Austria - epidemiology Bile Duct Neoplasms - mortality Bile Duct Neoplasms - surgery Bile Ducts, Intrahepatic - surgery Cholangiocarcinoma - mortality Cholangiocarcinoma - surgery Europe - epidemiology Female Follow-Up Studies Hepatectomy Humans Male Middle Aged North America - epidemiology Online First Online Only Original Investigation Retrospective Studies Sex Distribution Survival Rate - trends Young Adult |
| Title | A Multi-Institutional International Analysis of Textbook Outcomes Among Patients Undergoing Curative-Intent Resection of Intrahepatic Cholangiocarcinoma |
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