Benchmark performance of laparoscopic left lateral sectionectomy and right hepatectomy in expert centers.
This study aimed to establish benchmark values in laparoscopic left lateral sectionectomy (LLLS) and in laparoscopic right hepatectomy (LRH) from data of identified expert centers based on a composite indicator of healthcare quality.Data from a nationwide multicenter survey including all patients undergoing LLLS and LRH between 2000 and 2017 were analyzed. Textbook outcome (TO) completion was considered in patients fulfilling all of the six following characteristics: negative margins, no transfusion, no complication, no prolonged hospital stay, no readmission and no mortality. For each procedure, a cut-off of laparoscopic liver resections (LLR) volume by center associated to the completion of textbook outcome (TO) was identified using multivariable analysis. These cut-offs defined the expert centers. The benchmark values were set at the 75th percentile of median outcomes among these expert centers.Among 4,400 LLR performed in 29 centers, 855 LLLS patients and 488 LRH patients were identified. The overall incidences of TO after LLLS and LRH were 43.7% and 23.8%, respectively. LLR volume cut-offs of 25 LLR/year (OR=2.45; Bootstrap 95%CI=1.65 to 3.69; p=0.001) and 35 LLR/year (OR=2.55; Bootstrap 95%CI=1.34 to 5.63; p=0.003) were independently associated with completion of TO after LLLS and LRH, respectively. Eight centers in LLLS and six centers in LRH, including 516 and 346 LLLS/LRH patients respectively, reached theses cut-offs and were identified as expert centers. After LLLS, benchmark values of severe complication, mortality and TO completion were defined as ≤5.3%, ≤1.2% and ≥46.6%. After LRH, benchmark values of severe complication, mortality and TO completion were ≤20.4%, ≤2.8% and ≥24.2%.This study provides an up-to-date reference of the highest level of performance for LLLS and LRH.