Rates of textbook outcome achieved in patients undergoing liver and pancreatic surgery

Abstract

Abstract Textbook outcome (TO) is a composite measure that reflects the most desirable surgical results as a single indicator. The aim of this study was to assess the achievement of TO at a hepatopancreatobiliary (HPB) surgery unit in a Spanish tertiary hospital. Methods: Retrospective observational study of all consecutive patients who underwent HPB surgery over a 4-year period. Morbidity (defined according to the Clavien-Dindo classification) and mortality at 30 days, hospital stay, risk of morbidity and mortality according to the POSSUM scale and readmissions at 90 days were recorded. TO was considered when a patient presented no major complications (³IIIA), no mortality, no readmission, and not prolonged length of stay (LOS: £ 75th percentile of the sample). Results: A total of 283 patients were included (median age: 65 years, 65.4% men). Morbidity >IIIA was reported in 21.6%, and 5.7% died; median postoperative stay was 4 days. TO was achieved in 56.2% of patients. Comparing patients that presented TO with those that did not, significant differences were recorded for the type of procedure and the expected risk of morbidity and mortality calculated according to the POSSUM scale. There were significant differences between patients with major resections (TO rates of 46.3% in major hepatectomy and 52.5% in major pancreatectomy) and those with minor resections (rates of 67.7% in minor hepatectomy and 40.7% in minor pancreatectomy). Conclusion: The rate of TO in our series (56.2%) was like those published internationally. TO is a very useful management tool for assessing postoperative results.