[en] [en] BACKGROUND: Existing studies suggest a positive correlation between high compliance with enhanced recovery programs (ERP) and improved outcomes. While individual outcome measures have advantages, composite benchmarks, such as textbook outcome (TO), offer a more comprehensive assessment of healthcare performance. Given the link between ERP and postoperative outcomes, this study aims to investigate the impact of ERP on TO attainment after liver surgery (LS).
METHODS: A prospective multicenter cohort of patients undergoing LS and exposed to ERP from 2016 to 2022 in France was analyzed. The primary outcome was to compare the rates of TO achieved between patients with high ERP compliance (>70%) and those with low ERP compliance (<70%) after LS.
RESULTS: A total of 706 patients were included in the study, and 217 (30.7%) achieved TO: 170 patients with high ERP compliance (24%) versus 47 patients (6.6%) with low ERP compliance attained TO (p < 0.001). High ERP compliance was associated to an increased likelihood of achieving TO [odds ratio (OR) = 1.49 (95% CI: 1.01, 2.24); p = 0.049], while cholangiocarcinoma [OR = 0.11 (95% CI: 0.02, 0.39); p = 0.003], high complexity LS [OR = 0.22 (95% CI: 0.13, 0.36); p < 0.001], intraoperative hypotension requiring vasopressors [OR = 0.29 (95% CI: 0.10, 0.68); p = 0.010], and post-operative ileus [OR = 0.08 (95% CI: 0.00, 0.37); p = 0.013] were negatively associated to the likelihood of achieving TO.
CONCLUSIONS: Patients with high ERP compliance after LS experience elevated rates of TO, compared to those with low ERP compliance.
Disciplines :
Surgery Anesthesia & intensive care
Author, co-author :
Gosse, Juliette; Assistance Publique-Hôpitaux de Paris, Créteil, France ; Department of Digestive and Hepato-pancreatic-biliary Surgery AP-HP, Hôpital Henri-Mondor, Paris Est Créteil University, UPEC, Créteil, France
Mariani, Pascale; Department of Surgical Oncology, Institut Curie, PSL Research University, Mazarine, France ; Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
Cotte, Eddy; Service de chirurgie digestive et oncologique, Hôpital Lyon-Sud - CHU de Lyon, Lyon, France
Passot, Guillaume ; Service de chirurgie digestive et oncologique, Hôpital Lyon-Sud - CHU de Lyon, Lyon, France
Germain, Adeline; Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, Nancy, France
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
Dupre, Aurélien; Department of Surgical Oncology, Centre Léon Bérard, University Lyon, LabTau, Lyon, France
Bouhadiba, Toufik; Department of Surgical Oncology, Institut Curie, PSL Research University, Mazarine, France ; Francophone Group for Enhanced Recovery After Surgery (GRACE), Beaumont, France
Ayav, Ahmet; Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, Nancy, France
Thierry, Gabriel ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Combari-Ancellin, Prisca; Assistance Publique-Hôpitaux de Paris, Créteil, France ; Department of Digestive and Hepato-pancreatic-biliary Surgery AP-HP, Hôpital Henri-Mondor, Paris Est Créteil University, UPEC, Créteil, France
Atallah, Aziz; Assistance Publique-Hôpitaux de Paris, Créteil, France ; Department of Digestive and Hepato-pancreatic-biliary Surgery AP-HP, Hôpital Henri-Mondor, Paris Est Créteil University, UPEC, Créteil, France
Sommacale, Daniele; Université Paris-Est Créteil, UPEC, Créteil, France ; INSERM, Team "Virus Hépatologie Cancer", Créteil, France ; Department of Digestive and Hepato-pancreatic-biliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-University Hospital, Créteil, France ; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Av Marechal de Lattre - Tassigny, Créteil, France
Amaddeo, Giuliana; Université Paris-Est Créteil, UPEC, Créteil, France ; INSERM, Team "Virus Hépatologie Cancer", Créteil, France ; Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Créteil, France ; AP-HP, Hôpital Henri-Mondor, Créteil, France
Slim, Karem; Francophone Group for Enhanced Recovery After Surgery (GRACE), Pôle Santé République (ELSAN Group) Clermont-Ferrand, Clermont-Ferrand, France
Brustia, Raffaele ; Université Paris-Est Créteil, UPEC, Créteil, France ; INSERM, Team "Virus Hépatologie Cancer", Créteil, France ; Department of Digestive and Hepato-pancreatic-biliary Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor-University Hospital, Créteil, France ; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Av Marechal de Lattre - Tassigny, Créteil, France
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