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Textbook Outcomes in Liver Surgery: a Systematic Review

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Assessment of the quality of care among patients undergoing hepatectomy may be inadequate using traditional “siloed” postoperative surgical outcome metrics. In turn, the combination of several quality metrics into a single composite Textbook Outcome in Liver Surgery (TOLS) may be more representative of “ideal” surgical care.

Methods

Adhering to PRISMA guidelines, a search for primary articles on post-operative TOLS evaluation after hepatectomy was performed. Studies that did not present hepatectomy outcomes, pediatric or transplantation populations, duplicated series, and editorials were excluded. Studies were evaluated in aggregate for methodological variation, TOLS rates, factors associated with TOLS, hospital variation, and overall findings.

Results

Among 207 identified publications, 32 observational cohort studies were selected for inclusion in the review. There was a total of 90,077 hepatic resections performed from 1993 to 2020 in the analytic cohort. While TOLS definitions varied widely, all studies used an “all-or-none” composite structure combining a median of 5 (range: 4–7) discrete parameters. Observed TOLS rates varied in the different reported populations from 11.2 to 77.0%. TOLS was associated with patient, hospital, and operative factors.

Conclusions

This systematic review summarizes the contemporary international experience with TOLS to assess surgical performance following hepatobiliary surgery. TOLS is a single composite metric that may be more patient-centered, as well as better suited to quantify “optimal” care and compare performance among centers performing liver surgery.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Patrick J. Sweigert & Timothy M. Pawlik

  2. Department of Surgery, Hospital General Universitario Dr. Balmis, Pintor Baeza, 11, 03010, Alicante, Spain

    Jose M. Ramia, Celia Villodre & Silvia Carbonell-Morote

  3. Instituto de Investigacion Sanitaria y Biomedica de Alicante (ISABIAL), Alicante, Spain

    Jose M. Ramia, Celia Villodre & Silvia Carbonell-Morote

  4. Universidad Miguel Hernández, Alicante, Spain

    Jose M. Ramia

  5. Hospital General Universitario de Guadalajara, Guadalajara, Spain

    Roberto De-la-Plaza

  6. Hospital Miguel Servet, Zaragoza, Spain

    Mario Serradilla

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Sweigert, P.J., Ramia, J.M., Villodre, C. et al. Textbook Outcomes in Liver Surgery: a Systematic Review. J Gastrointest Surg 27, 1277–1289 (2023). https://doi.org/10.1007/s11605-023-05673-1

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