Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Dutch Hepato Biliary Audit Group, Arthur K E Elfrink, Sanne Nieuwenhuizen, M Petrousjka van den Tol, Mark C Burgmans, Warner Prevoo, Marielle M E Coolsen, Peter B van den Boezem, Otto M van Delden, Jeroen Hagendoorn, Gijs A Patijn, Wouter K G Leclercq, Mike S L Liem, Arjen M Rijken, Cornelis Verhoef, Koert F D Kuhlmann, Simeon J S Ruiter, Dirk J Grünhagen, Joost M Klaase, Niels F M KokMartijn R Meijerink, Rutger-Jan Swijnenburg

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Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation.

Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery.

Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy.

Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.

Original languageEnglish
Pages (from-to)827-839
Number of pages13
Issue number6
Early online date17-Nov-2020
Publication statusPublished - Jun-2021



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