Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

AKE Elfrink, EW van Zwet, RJ Swijnenburg, M Dulk, PB van den Boezem, JS Mieog, WWT Riele, GA Patijn, WKG Leclercq, DJ Lips, AM Rijken, Kees Verhoef, KFD Kuhlmann, CI Buis, K Bosscha, EJT Belt, M Vermaas, NT van Heek, SJ Oosterling, H TorrengaHH Eker, ECJ Consten, HA Marsman, MWJ Wouters, NFM Kok, Dirk Grünhagen, JM Klaase, MGH Besselink, MT de Boer, CHC Dejong, TM Gulik, J Hagendoorn, FHJ Hoogwater, IQ Molenaar, MS Liem

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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.

Original languageEnglish
Pages (from-to)649-659
Number of pages11
JournalEuropean Journal of Surgical Oncology
Issue number3
Publication statusPublished - Mar 2021

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© 2020 University Medical Center Groningen


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