Analysis of a modified surgical desirability of outcome ranking (mDOOR) among patients undergoing surgery for Hepatocellular carcinoma.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-03-05 DOI:10.1016/j.hpb.2025.02.013

Giovanni Catalano, Laura Alaimo, Odysseas P Chatzipanagiotou, Andrea Ruzzenente, Federico Aucejo, Hugo P Marques, Vincent Lam, Tom Hugh, Nazim Bhimani, Minoru Kitago, Itaru Endo, Guillaume Martel, Irinel Popescu, François Cauchy, George A Poultsides, Ana Gleisner, Timothy M Pawlik

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引用次数: 0

Abstract

Background: Composite measures represent a validated method for evaluating surgical care quality. We defined a modified Desirability Of Outcome Ranking (mDOOR) and compared it with textbook outcome (TO).

Methods: In this cohort study, patients undergoing curative-intent surgery for HCC were identified from an international cohort. The performance and agreement of mDOOR, TO, and other measures of postoperative course with respect to overall survival (OS) were compared using Harrell's Concordance-index (C-index) and Cohen's kappa.

Results: Among 2181 patients, 77.6 % (n = 1692) achieved the most desirable outcome (i.e., DOOR1), whereas roughly one-half of patients achieved TO (n = 1,171, 53.7 %). Patients with lower mDOOR had a better 5-year OS compared with patients with higher mDOOR (64.7 % vs. 51.9 %; p < 0.001). On multivariable analysis, higher mDOOR was associated with worse OS (HR 1.35, 95%CI 1.28-1.44; p < 0.001). The mDOOR demonstrated improved performance compared with the comprehensive complication index (C-index: 0.696 vs. 0.649; p < 0.001) and the Accordion score (C-index: 0.696 vs. 0.653; p = 0.002).

Conclusion: Roughly 4 out of 5 patients achieved the most desirable outcome. Higher mDOOR was associated with worse long-term outcomes. A composite outcome ranking may provide more insight on surgical outcomes, complementing traditional metrics.

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对接受肝细胞癌手术的患者进行改良手术结果可取性排名（mDOOR）分析。

背景：综合测量是评估外科护理质量的有效方法。我们定义了一个改进的结果排序的可取性（mDOOR），并将其与教科书结果（TO）进行比较。方法：在这项队列研究中，从一个国际队列中确定了接受HCC治疗目的手术的患者。采用Harrell’s concorance -index （C-index）和Cohen’s kappa比较mDOOR、TO和其他术后总生存期（OS）指标的表现和一致性。结果：在2181例患者中，77.6% （n = 1692）达到了最理想的结果（即DOOR1），而大约一半的患者达到了TO （n = 1171, 53.7%）。与mDOOR较高的患者相比，mDOOR较低的患者有更好的5年OS (64.7% vs 51.9%；结论：5例患者中约有4例达到了最理想的结果。较高的mDOOR与较差的长期预后相关。综合结果排名可以对手术结果提供更深入的了解，补充了传统的指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).