It is well known that radical intent surgery is,as of today,the only curative treatment available for perihilar cholangiocarcinoma(pCCA);the standard surgical procedure includes major hepatectomy with caudate lobe res...It is well known that radical intent surgery is,as of today,the only curative treatment available for perihilar cholangiocarcinoma(pCCA);the standard surgical procedure includes major hepatectomy with caudate lobe resection and extrahepatic bile duct resection(1).A recent paper set the benchmark values for pCCA surgery:in this paper,acceptable benchmark values for morbidity.展开更多
Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessmen...Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative complications.However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently,two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0(no complications) to 100(patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.展开更多
Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the co...Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency.The payment system in place often rewards the volume of services provided rather than the quality of patients’clinical outcomes.Without a thorough registration of PC,the economic costs involved cannot be determined.An accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic costs.This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various recommendations.The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs.Patients,the health authorities,and society as a whole are sure to benefit.展开更多
BACKGROUND Liver transplant(LT)is a complex procedure with frequent postoperative complications.In other surgical procedures such as gastrectomy,esophagectomy or resection of liver metastases,these complications are a...BACKGROUND Liver transplant(LT)is a complex procedure with frequent postoperative complications.In other surgical procedures such as gastrectomy,esophagectomy or resection of liver metastases,these complications are associated with poorer long-term survival.It is possible this happens in LT but there are not enough data to establish this relationship.AIM To analyze the possible influence of postoperative complications on long-term survival and the ability of the comprehensive complication index(CCI)to predict this.METHODS Retrospective study in a tertiary-level university hospital.The 164 participants were all patients who received a LT from January 2012 to July 2019.The follow-up was done in the hospital until the end of the study or death.Comorbidity and risk after transplantation were calculated using the Charlson and balance of risk(BAR)scores,respectively.Postoperative complications were graded according to the Clavien-Dindo classification and the CCI.To assess the CCI cut-off value with greater prognostic accuracy a receiver operating characteristic(ROC)curve was built,with calculation of the area under the curve(AUC).Overall survival was estimated according to the Kaplan-Meier test and log-rank test.Groups were compared by the Mann-Whitney test.For the multivariable analysis the Cox regression was used.RESULTS The mean follow-up time of the cohort was 37.76(SD=24.5)mo.A ROC curve of CCI with 5-year survival was built.The AUC was 0.826(0.730-0.922),P<0.001.The cut-off was calculated by means of the Youden index with a result of 35.95.The sensitivity was 84.6%and the specificity 61.3%.Survival curves for comparison of patients with CCI score<36 vs≥36 were calculated.The estimated 5-year survival was 57.65 and 43.95 months,respectively(log-rank<0.001).This suggests that patients with more severe complications exhibit worse long-term survival.Other cut-off values were analysed.Comparison between patients with CCI<33.5 vs>33.5(33.5=median CCI value)showed estimated 5-year survival was 57.4 and 45.71 months,respectively(log-rank<0.0001).Dividing patients according to the mode CCI value(20.9)showed an estimated 5-year survival of 60 mo for a CCI below 20.9 vs 57 mo for a CCI above 20.9(log-rank=0.147).The univariate analysis did not show any association between individual complications and long-term survival.A multivariate analysis was carried out to analyse the possible influence of CCI,Charlson comorbidity index,BAR and hepatocellular carcinoma on survival.Only the CCI score showed significant influence on long-term survival.CONCLUSION A complicated postoperative period–well-defined by means of the CCI score–can influence not only short-term survival,but also long-term survival.展开更多
文摘It is well known that radical intent surgery is,as of today,the only curative treatment available for perihilar cholangiocarcinoma(pCCA);the standard surgical procedure includes major hepatectomy with caudate lobe resection and extrahepatic bile duct resection(1).A recent paper set the benchmark values for pCCA surgery:in this paper,acceptable benchmark values for morbidity.
文摘Postoperative complications represent a basic quality indicator for measuring outcomes at surgical units. At present, however, they are not systematically measured in all surgical procedures. A more accurate assessment of their impact could help to evaluate the real morbidity associated with different surgical interventions, establish measures for improvement, increase efficiency and identify benchmarking services. The Clavien-Dindo Classification is the most widely used system worldwide for assessing postoperative complications.However, the postoperative period is summarized by the most serious complication without taking into account others of lesser magnitude. Recently,two new scoring systems have emerged, the Comprehensive Complication Index and the Complication Severity Score, which include all postoperative complications and quantify them from 0(no complications) to 100(patient’s death), These allow the comparison of results. It is important to train surgical staff to report and classify complications and to record 90-d morbidity rates in all patients. Comparisons with other services must take into account patient comorbidities and the complexity of the particular surgical procedure. To avoid subjectivity and bias, external audits are necessary. In addition, ensuring transparency in the reporting of the results is an urgent obligation.
文摘Postoperative complications(PC)are a basic health outcome,but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs.Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency.The payment system in place often rewards the volume of services provided rather than the quality of patients’clinical outcomes.Without a thorough registration of PC,the economic costs involved cannot be determined.An accurate,reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results,and bring down the economic costs.This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index,discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established,and makes various recommendations.The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs.Patients,the health authorities,and society as a whole are sure to benefit.
文摘BACKGROUND Liver transplant(LT)is a complex procedure with frequent postoperative complications.In other surgical procedures such as gastrectomy,esophagectomy or resection of liver metastases,these complications are associated with poorer long-term survival.It is possible this happens in LT but there are not enough data to establish this relationship.AIM To analyze the possible influence of postoperative complications on long-term survival and the ability of the comprehensive complication index(CCI)to predict this.METHODS Retrospective study in a tertiary-level university hospital.The 164 participants were all patients who received a LT from January 2012 to July 2019.The follow-up was done in the hospital until the end of the study or death.Comorbidity and risk after transplantation were calculated using the Charlson and balance of risk(BAR)scores,respectively.Postoperative complications were graded according to the Clavien-Dindo classification and the CCI.To assess the CCI cut-off value with greater prognostic accuracy a receiver operating characteristic(ROC)curve was built,with calculation of the area under the curve(AUC).Overall survival was estimated according to the Kaplan-Meier test and log-rank test.Groups were compared by the Mann-Whitney test.For the multivariable analysis the Cox regression was used.RESULTS The mean follow-up time of the cohort was 37.76(SD=24.5)mo.A ROC curve of CCI with 5-year survival was built.The AUC was 0.826(0.730-0.922),P<0.001.The cut-off was calculated by means of the Youden index with a result of 35.95.The sensitivity was 84.6%and the specificity 61.3%.Survival curves for comparison of patients with CCI score<36 vs≥36 were calculated.The estimated 5-year survival was 57.65 and 43.95 months,respectively(log-rank<0.001).This suggests that patients with more severe complications exhibit worse long-term survival.Other cut-off values were analysed.Comparison between patients with CCI<33.5 vs>33.5(33.5=median CCI value)showed estimated 5-year survival was 57.4 and 45.71 months,respectively(log-rank<0.0001).Dividing patients according to the mode CCI value(20.9)showed an estimated 5-year survival of 60 mo for a CCI below 20.9 vs 57 mo for a CCI above 20.9(log-rank=0.147).The univariate analysis did not show any association between individual complications and long-term survival.A multivariate analysis was carried out to analyse the possible influence of CCI,Charlson comorbidity index,BAR and hepatocellular carcinoma on survival.Only the CCI score showed significant influence on long-term survival.CONCLUSION A complicated postoperative period–well-defined by means of the CCI score–can influence not only short-term survival,but also long-term survival.
