Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases
Arthur K.E. Elfrink, Erik W. van Zwet, Rutger‐Jan Swijnenburg, Marcel den Dulk, Peter B. van den Boezem, J. Sven D. Mieog, Wouter W. te Riele, Gijs A. Patijn, Wouter K. G. Leclercq, Daan J. Lips, Arjen M. Rijken, Cornelis Verhoef, Koert F.D. Kuhlmann, Carlijn I. Buis, Koop Bosscha, Eric J.T. Belt, Maarten Vermaas, N. Tjarda van Heek, Steven J. Oosterling, Hans Torrenga, Hasan H. Eker, Esther C. J. Consten, Hendrik A. Marsman, Michel W.J.M. Wouters, Niels F.M. Kok, Dirk J. Grünhagen, Joost M. Klaase, Marc G. Besselink, Marieke T. de Boer, C. Dejong, Thomas M. van Gulik, Jeroen Hagendoorn, Frederik H.J. Hoogwater, I. Quintus Molenaar, Mike S.L. Liem
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.