In 2013, the nationwide Dutch Hepato Biliary Audit (DHBA) was initiated. The aim of this study was to evaluate changes in indications for and outcomes of liver surgery in the last decade. This nationwide study included all patients who underwent liver surgery for four indications, including colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), and intrahepatic– and perihilar cholangiocarcinoma (iCCA – pCCA) between 2014 and 2022. Trends in postoperative outcomes were evaluated separately for each indication using multilevel multivariable logistic regression analyses. This study included 8057 procedures for CRLM, 838 for HCC, 290 for iCCA, and 300 for pCCA. Over time, these patients had higher risk profiles (more ASA-III patients and more comorbidities). Adjusted mortality decreased over time for CRLM, HCC and iCCA, respectively aOR 0.83, 95%CI 0.75–0.92 aOR 0.86, 95%CI 0.75–0.99, ; aOR 0.40, 95%CI 0.20–0.73, . Failure to rescue (FTR) also decreased for these groups, respectively aOR 0.84, 95%CI 0.76–0.93, P = 0.001; aOR 0.81, 95%CI 0.68–0.97, aOR 0.29, 95%CI 0.08–0.84, ). For iCCA severe complications (aOR 0.65 95%CI 0.43–0.99) also decreased. No significant outcome differences were observed in pCCA. The number of centres performing liver resections decreased from 26 to 22 between 2014 and 2022, while median annual volumes did not change (40–49, P = 0.66). Over time, postoperative mortality and FTR decreased after liver surgery, despite treating higher-risk patients. The DHBA continues its focus on providing feedback and benchmark results to further enhance outcomes.

中文翻译：

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肝脏手术的结果：荷兰十年强制全国审计

2013年，全国范围内的荷兰肝胆审计（DHBA）启动。本研究的目的是评估过去十年肝脏手术适应症和结果的变化。这项全国性研究纳入了 2014 年至 2022 年间因四种适应症接受肝脏手术的所有患者，包括结直肠肝转移瘤 (CRLM)、肝细胞癌 (HCC) 以及肝内和肝门周围胆管癌 (iCCA – pCCA)。评估了术后结果的趋势使用多级多变量逻辑回归分析分别针对每种适应症。该研究包括 8057 例 CRLM 手术、838 例 HCC 手术、290 例 iCCA 手术和 300 例 pCCA 手术。随着时间的推移，这些患者的风险状况更高（更多 ASA-III 患者和更多合并症）。 CRLM、HCC 和 iCCA 的调整死亡率随着时间的推移而下降，分别 aOR 0.83, 95%CI 0.75–0.92 aOR 0.86, 95%CI 0.75–0.99，； aOR 0.40，95%CI 0.20–0.73，.这些组的救援失败 (FTR) 也有所下降，分别 aOR 0.84，95%CI 0.76–0.93，P = 0.001； aOR 0.81，95%CI 0.68–0.97，aOR 0.29，95%CI 0.08–0.84，）。对于 iCCA 严重并发症（aOR 0.65 95%CI 0.43–0.99）也有所下降。 pCCA 中没有观察到显着的结果差异。 2014 年至 2022 年间，进行肝切除的中心数量从 26 个减少到 22 个，而年手术量中位数没有变化（40-49 个，P = 0.66）。随着时间的推移，尽管治疗了高危患者，肝脏手术后的术后死亡率和 FTR 却有所下降。 DHBA 继续专注于提供反馈和基准结果，以进一步提高成果。