Assessment of Textbook Outcome in Laparoscopic and Open Live
The findings of this JAMA Surgery study suggest that textbook outcome in laparoscopic and open liver surgery (TOLS) is an important tool to assess patient-level hospital performance and may have utility in optimizing patient outcomes after laparoscopic and open liver resection.

The objective was to obtain international agreement on the definition of Textbook outcome (TO) in liver surgery (TOLS) and to assess the incidence of TO in laparoscopic liver resection (LLR) and open liver resection (OLR) in a large international multicenter database using a propensity-score matched analysis.

Patients undergoing LLR or OLR for all liver diseases were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach an agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated.

A total of 8188 patients were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR.

--On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases, cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments, anatomically major resection, and non-anatomical resection were associated with a worse TOLS rate after LLR.

--For OLR, only histological diagnosis of cholangiocarcinoma and tumor size of 30 mm or more were associated with a worse TOLS rate.

In this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.

Source: https://jamanetwork.com/journals/jamasurgery/article-abstract/2780522
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