Implementation and first results of a mandatory, nationwide audit on liver surgery

Leonie R van der Werf*, Niels F M Kok, Dutch Hepato Biliary Audit Group, Carlijn I Buis, Dirk J Grünhagen, Frederik J H Hoogwater, Rutger Jan Swijnenburg, Marcel den Dulk, Kees C H C Dejong, Joost M Klaase

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1400-1410
Number of pages11
Issue number10
Publication statusPublished - 1 Oct 2019

Bibliographical note

Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.


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