TY - JOUR
T1 - Implementation and first results of a mandatory, nationwide audit on liver surgery
AU - van der Werf, Leonie R.
AU - Kok, Niels F.M.
AU - Buis, Carlijn I.
AU - Grünhagen, Dirk J.
AU - Hoogwater, Frederik J.H.
AU - Swijnenburg, Rutger Jan
AU - Dulk, Marcel den
AU - Dejong, Kees C.H.C.
AU - Klaase, Joost M.
AU - de Boer, Marieke T.
AU - Besselink, Marc G.H.
AU - van Gullik, Thomas M.
AU - Hagendoorn, Jeroen
AU - van Hillegersberg, Richard
AU - Liem, Mike S.L.
AU - Molenaar, I. Quintus
AU - Patijn, Gijs A.
AU - Porte, Robert J.
AU - te Riele, Wouter W.
AU - van Santvoort, Hjalmar C.
AU - Verhoef, Kees
AU - Burgmans, Marc C.
AU - van Delden, Otto M.
AU - van der Leij, Christiaan
AU - Meijerink, Martijn R.
AU - Moelker, Adriaan
AU - Prevoo, Warner
N1 - Funding Information:
The DHBA was initiated by the Liver Surgery working group in collaboration with the Dutch Institute for Clinical Auditing (DICA). DICA, founded in 2009, aims to enhance clinical auditing initiatives in the Netherlands. 6 The Liver Surgery working group was established in 2003 and represents all Dutch liver surgeons. The DHBA was initially funded by quality improvement grants donated by the Dutch Associated Health Insurance Companies and since 2016, the audit is structurally funded by the Dutch Associated Health Insurance Company. All participating hospitals are responsible for registration of their own data. Surgeons have the responsibility for this data registration. To limit registration burden, at the start of the DHBA it was chosen to not include long-term follow-up information and 90-day morbidity, mortality and readmissions. Nationwide coverage of the audit was stimulated via the Association of Surgeons of the Netherlands (NVvH), and registration of patients has been one of the requirements of the guidelines of the Foundation of oncological cooperation (SONCOS) since 2013. 7 These guidelines include a minimum average annual volume of 20 liver resections over a period of three years per hospital, and specific requirements for the team, i.e. two surgeons with particular experience in liver surgery and 24/7 coverage of an interventional radiologist. A clinical audit board and a scientific committee were formed consisting of hepatobiliary surgeons.
Publisher Copyright:
© 2019 International Hepato-Pancreato-Biliary Association Inc.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: The Dutch Hepato Biliary Audit (DHBA) was initiated in 2013 to assess the national quality of liver surgery. This study aimed to describe the initiation and implementation of this audit along with an overview of the results and future perspectives. Methods: Registry of patients undergoing liver surgery for all primary and secondary liver tumors in the DHBA is mandatory. Weekly, benchmarked information on process and outcome measures is reported to surgical teams. In this study, the first results of patients with colorectal liver metastases were presented, including results of data verification. Results: Between 2014 and 2017, 6241 procedures were registered, including 4261 (68%) resections for colorectal liver metastases. For minor- and major liver resections for colorectal liver metastases, the median [interquartile range] hospital stay was 6 [4–8] and 8 [6–12] days, respectively. A postoperative complicated course (complication leading to >14 days of hospital stay, reintervention or death) occurred in 26% and 43% and the 30-day/in-hospital mortality was 1% and 4%, respectively. The completeness of data was 97%. In 3.6% of patients, a complicated postoperative course was erroneously omitted. Conclusion: Nationwide implementation of the DHBA has been successful. This was the first step in creating a complete evaluation of the quality of liver surgery.
AB - Background: The Dutch Hepato Biliary Audit (DHBA) was initiated in 2013 to assess the national quality of liver surgery. This study aimed to describe the initiation and implementation of this audit along with an overview of the results and future perspectives. Methods: Registry of patients undergoing liver surgery for all primary and secondary liver tumors in the DHBA is mandatory. Weekly, benchmarked information on process and outcome measures is reported to surgical teams. In this study, the first results of patients with colorectal liver metastases were presented, including results of data verification. Results: Between 2014 and 2017, 6241 procedures were registered, including 4261 (68%) resections for colorectal liver metastases. For minor- and major liver resections for colorectal liver metastases, the median [interquartile range] hospital stay was 6 [4–8] and 8 [6–12] days, respectively. A postoperative complicated course (complication leading to >14 days of hospital stay, reintervention or death) occurred in 26% and 43% and the 30-day/in-hospital mortality was 1% and 4%, respectively. The completeness of data was 97%. In 3.6% of patients, a complicated postoperative course was erroneously omitted. Conclusion: Nationwide implementation of the DHBA has been successful. This was the first step in creating a complete evaluation of the quality of liver surgery.
UR - http://www.scopus.com/inward/record.url?scp=85063357558&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2019.02.021
DO - 10.1016/j.hpb.2019.02.021
M3 - Article
C2 - 30926330
AN - SCOPUS:85063357558
SN - 1365-182X
VL - 21
SP - 1400
EP - 1410
JO - HPB
JF - HPB
IS - 10
ER -