Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Variazioni nei risultati rischio-aggiustati in 4318 resezioni epatiche laparoscopiche

Lo studio dimostra che i chirurghi possono agire secondo le linee guida nell'interesse del paziente, modificando l'approccio operatorio in relazione alle diverse indicazioni e alle esperienze diverse, ma in definitiva fornendo la stessa qualità di assistenza. La calcolatrice proposto dallo studio può standardizzare il rischio. I suoi risultati possono essere uno strumento prezioso per monitorare le prestazioni delle resezioni epatiche laparoscopiche e per adottare misure sanitarie tempestive per correggere eventuali sottoperformance.
Alessandro Cucchetti, Luca Aldrighetti, Francesca Ratti, Alessandro Ferrero, Alfredo Guglielmi, Felice Giuliante, Umberto Cillo, Vincenzo Mazzaferro, Luciano De Carlis, Giorgio Ercolani, Giuseppe Maria Ettorre, Fabrizio Benedetto, Raffaele Dalla Valle, Salvatore Gruttadauria, Elio Jovine, Ugo Boggi, Leonardo Vincenti, Roberto Santambrogio, Antonio Giuliani, Guido Torzilli, Giuliano Zimmiti, Alberto Brolese, Andrea Belli, Matteo Ravaioli, Antonio Frena, Giorgio Ettore Rossi, Gian Luca Grazi, Fausto Zamboni, Stefano Berti, Fulvio Calise, Marco Massani, Luca Morelli, Marco Filauro, Giuseppe Tisone, Andrea Coratti, Giuseppe Navarra, Raffaele Romito, Graziano Ceccarelli, Giulio Belli, Guido Griseri, Adelmo Antonucci, Pietro Mezzatesta, Luigi Veneroni, Marcello Schiavo, Michele Colledan, Amilcare Parisi, Silvio Guerriero, Marco Spada, Giacomo Batignani, Giovanni Sgroi, Piero Floridi, Luigi Boni, Pietro Maida, Dario Ribero, Giuliano La Barba: Variations in risk-adjusted outcomes following 4318 laparoscopic liver resections. In: Journal of Hepato-Biliary-Pancreatic Sciences, vol. 29, no. 5, pp. 521 – 530, 2022, ISSN: 18686974, (Cited by: 0; All Open Access, Green Open Access).

Abstract

Background/Purpose: Quality measures in surgery are important to establish appropriate levels of care and to develop improvement strategies. The purpose of this study was to provide risk-adjusted outcome measures after laparoscopic liver resection (LLR). Methods: Data from a prospective, multicenter database involving 4318 patients submitted to LLRs in 41 hospitals from an intention-to-treat approach (2014–2020) were used to analyze heterogeneity (I2) among centers and to develop a risk-adjustment model on outcome measures through multivariable mixed-effect models to account for confounding due to case-mix. Results: Involved hospitals operated on very different patients: the largest heterogeneity was observed for operating in the presence of previous abdominal surgery (I2:79.1%), in cirrhotic patients (I2:89.3%) suffering from hepatocellular carcinoma (I2:88.6%) or requiring associated intestinal resections (I2:82.8%) and in regard to technical complexity (I2 for the most complex LLRs: 84.1%). These aspects determined substantial or large heterogeneity in overall morbidity (I2:84.9%), in prolonged in-hospital stay (I2:86.9%) and in conversion rate (I2:73.4%). Major complication had medium heterogeneity (I2:46.5%). The heterogeneity of mortality was null. Risk-adjustment accounted for all of this variability and the final risk-standardized conversion rate was 8.9%, overall morbidity was 22.1%, major morbidity was 5.1% and prolonged in-hospital stay was 26.0%. There were no outliers among the 41 participating centers. An online tool was provided. Conclusions: A benchmark for LLRs including all eligible patients was provided, suggesting that surgeons can act accordingly in the interest of the patient, modifying their approach in relation to different indications and different experience, but finally providing the same quality of care. © 2022 The Authors. Journal of Hepato-Biliary-Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

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