Benchmarking a new tertiary referral center for hepato-biliary surgery through a critical systematic review of available literature. (December 2020)

• Record Type: Journal Article
• Authors: Ercolani, Giorgio; D'Acapito, Fabrizio; Solaini, Leonardo; La Barba, Giuliano; Gardini, Andrea; Fiorino, Leonardo; Cucchetti, Alessandro
• Is Part Of: International journal of surgery. Volume 84(2020)
• Page Start: 78
• Page End: 84
• Publication Date: 2020-12
• Subjects: Benchmarking -- Hepatic surgery -- Hepatectomy -- Morbidity -- Mortality; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2020.10.014
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Studies reporting benchmark values for surgical procedures should provide instruments for comparison, gap analysis and adoption of corrective measures to improve the outcome. Methods: A systematic search was performed to identify articles containing the MESH terms "benchmarking" AND "hepatectomy" . An Institutional Review Board-approved database of all hepato-biliary surgical procedures, performed in a new tertiary referral surgical unit was used for benchmarking results with the values reported in the literature. Results: Five articles were suitable for benchmarking: 3 based benchmark values (BMV) on the 75th percentiles of surgical outcomes among high-volume centers, one study provided BMV on the "Achievable Bench-mark of Care" and one study provided BMV on the 75th percentiles through a Bayesian prediction. When we benchmarked our surgical experience of 320 hepatic resections, we found margins for improvement for open major hepatectomies and for laparoscopic multiple resections/concomitant bowel resections but it was impossible to compare homogeneous sub-groups of patients for most of the procedures due to the lack of high-quality literature data. Conclusion: Benchmarking a surgical experience with the BMV provided in literature was attempted but unfortunately the lack of a standardized way for conducting benchmark analysis did not allow, at present, reliable quality comparison and improvement. Highlights: Reference values (benchmark) are necessary to provide useful information for corrective clinical and health policy decisions. Benchmarking is the practice of comparing performance metrics of a specific setting with the benchmark. Several attempts have been made to set benchmark values in liver surgery with promising results. A first attempt of benchmarking our own surgical experience with published literature is presented.