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  • 1
    Online Resource
    Online Resource
    Impact of the COVID-19 pandemic on surgical care in the Netherlands
    Oxford University Press (OUP) ; 2022
    In:  British Journal of Surgery Vol. 109, No. 12 ( 2022-11-22), p. 1282-1292
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 12 ( 2022-11-22), p. 1282-1292
    Abstract: The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands. Methods A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018–2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates. Results Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018–2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P & lt; 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P & lt; 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P & lt; 0.001). Conclusion The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znac301
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2006309-X
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  • 2
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    A nationwide assessment of hepatocellular adenoma resection: Indications and pathological discordance
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Hepatology Communications Vol. 7, No. 1 ( 2022-11-2), p. e2110-e2110
    Details
    In: Hepatology Communications, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 1 ( 2022-11-2), p. e2110-e2110
    Abstract: Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant transformation. Data on the indication for surgery are scarce. We analyzed indications and outcome of patients operated for HCAs  〈  50 mm compared to HCAs ≥ 50 mm. Changes in final postoperative diagnosis were assessed. We performed a retrospective study that included patients who underwent resection for (suspected) HCAs in the Netherlands from 2014 to 2019. Indication for resection was analyzed and stratified for small ( 〈 50 mm) and large (≥50 mm) tumors. Logistic regression analysis was performed on factors influencing change in tumor diagnosis. Out of 222 patients who underwent surgery, 44 (20%) patients had a tumor 〈 50 mm. Median age was 46 (interquartile range [IQR], 33–56) years in patients with small tumors and 37 (IQR, 31–46) years in patients with large tumors ( p  = 0.016). Patients with small tumors were more frequently men (21% vs. 5%, p  = 0.002). Main indications for resection in patients with small tumors were suspicion of (pre)malignancy (55%), (previous) bleeding (14%), and male sex (11%). Patients with large tumors received operations because of tumor size 〉 50 mm (52%), suspicion of (pre)malignancy (28%), and (previous) bleeding (5.1%). No difference was observed in HCA‐subtype distribution between small and large tumors. Ninety‐six (43%) patients had a postoperative change in diagnosis. Independent risk factors for change in diagnosis were tumor size 〈 50 mm (adjusted odds ratio [aOR], 3.4; p   〈  0.01), male sex (aOR, 3.7; p  = 0.03), and lack of hepatobiliary contrast‐enhanced magnetic resonance imaging (CE‐MRI) (aOR, 1.8; p  = 0.04). Resection for small (suspected) HCAs was mainly indicated by suspicion of (pre)malignancy, whereas for large (suspected) HCAs, tumor size was the most prevalent indication. Male sex, tumor size  〈 50 mm, and lack of hepatobiliary CE‐MRI were independent risk factors for postoperative change in tumor diagnosis.
    Type of Medium: Online Resource
    ISSN: 2471-254X
    URL: Article
    DOI: 10.1002/hep4.2110
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2881134-3
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  • 3
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    Practice variation and outcomes of minimally invasive minor liver resections in patients with colorectal liver metastases: a population-based study
    Springer Science and Business Media LLC ; 2023
    In:  Surgical Endoscopy Vol. 37, No. 8 ( 2023-08), p. 5916-5930
    Details
    In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 37, No. 8 ( 2023-08), p. 5916-5930
    Abstract: In 2017, the Southampton guideline stated that minimally invasive liver resections (MILR) should considered standard practice for minor liver resections. This study aimed to assess recent implementation rates of minor MILR, factors associated with performing MILR, hospital variation, and outcomes in patients with colorectal liver metastases (CRLM). Methods This population-based study included all patients who underwent minor liver resection for CRLM in the Netherlands between 2014 and 2021. Factors associated with MILR and nationwide hospital variation were assessed using multilevel multivariable logistic regression. Propensity-score matching (PSM) was applied to compare outcomes between minor MILR and minor open liver resections. Overall survival (OS) was assessed with Kaplan–Meier analysis on patients operated until 2018. Results Of 4,488 patients included, 1,695 (37.8%) underwent MILR. PSM resulted in 1,338 patients in each group. Implementation of MILR increased to 51.2% in 2021. Factors associated with not performing MILR included treatment with preoperative chemotherapy (aOR 0.61 CI:0.50–0.75, p   〈  0.001), treatment in a tertiary referral hospital (aOR 0.57 CI:0.50–0.67, p   〈  0.001), and larger diameter and number of CRLM. Significant hospital variation was observed in use of MILR (7.5% to 93.0%). After case-mix correction, six hospitals performed fewer, and six hospitals performed more MILRs than expected. In the PSM cohort, MILR was associated with a decrease in blood loss (aOR 0.99 CI:0.99–0.99, p   〈  0.01), cardiac complications (aOR 0.29, CI:0.10–0.70, p  = 0.009), IC admissions (aOR 0.66, CI:0.50–0.89, p  = 0.005), and shorter hospital stay (aOR CI:0.94–0.99, p   〈  0.01). Five-year OS rates for MILR and OLR were 53.7% versus 48.6%, p  = 0.21. Conclusion Although uptake of MILR is increasing in the Netherlands, significant hospital variation remains. MILR benefits short-term outcomes, while overall survival is comparable to open liver surgery. Graphical abstract
    Type of Medium: Online Resource
    ISSN: 0930-2794 , 1432-2218
    URL: Article
    DOI: 10.1007/s00464-023-10010-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1463171-4
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  • 4
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    Online Resource
    Correction to: Development of a data-driven case-mix adjustment model for comparison of hospital performance in hip fracture care
    Springer Science and Business Media LLC ; 2022
    In:  Archives of Osteoporosis Vol. 17, No. 1 ( 2022-12)
    Details
    In: Archives of Osteoporosis, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2022-12)
    Type of Medium: Online Resource
    ISSN: 1862-3522 , 1862-3514
    URL: Article
    DOI: 10.1007/s11657-022-01121-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2253231-6
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  • 5
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    Case-mix adjustment to compare colonoscopy performance between endoscopy centers: a nationwide registry study
    Georg Thieme Verlag KG ; 2022
    In:  Endoscopy Vol. 54, No. 05 ( 2022-05), p. 455-462
    Details
    In: Endoscopy, Georg Thieme Verlag KG, Vol. 54, No. 05 ( 2022-05), p. 455-462
    Abstract: Background Nonmodifiable patient and endoscopy characteristics might influence colonoscopy performance. Differences in these so-called case-mix factors are likely to exist between endoscopy centers. This study aimed to examine the importance of case-mix adjustment when comparing performance between endoscopy centers. Methods Prospectively collected data recorded in the Dutch national colonoscopy registry between 2016 and 2019 were retrospectively analyzed. Cecal intubation rate (CIR) and adequate bowel preparation rate (ABPR) were analyzed. Additionally, polyp detection rate (PDR) was studied in screening colonoscopies following a positive fecal immunochemical test (FIT). Variation in case-mix factors between endoscopy centers and expected outcomes for each performance measure were calculated per endoscopy center based on case-mix factors (sex, age, American Society of Anesthesiologist [ASA] score, indication) using multivariable logistic regression. Results 363 840 colonoscopies were included from 51 endoscopy centers. Mean percentages per endoscopy center were significantly different for age 〉  65 years, male patients, ASA ≥ III, and diagnostic colonoscopies (all P  〈  0.001). In the FIT-positive screening population, significant differences were observed between endoscopy centers for age 〉  65 years, male patients, and ASA ≥ III (all P ≤ 0.001). The expected CIR, ABPR, and PDR ranged from 95.0 % to 96.9 %, from 93.6 % to 96.4 %, and from 76.2 % to 79.1 %, respectively. Age, sex, ASA classification, and indication were significant case-mix factors for CIR and ABPR. In the FIT-positive screening population, age, sex, and ASA classification were significant case-mix factors for PDR. Conclusion Our findings emphasize the importance of considering case-mix adjustment when comparing colonoscopy performance measures between endoscopy centers.
    Type of Medium: Online Resource
    ISSN: 0013-726X , 1438-8812
    URL: Article
    DOI: 10.1055/a-1637-9651
    RVK:
    XA 41100
    RVK:
    YC 4905
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2026213-9
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  • 6
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    Online Resource
    Minimally Invasive Oncologic Upper Gastrointestinal Surgery can be Performed Safely on all Weekdays: A Nationwide Cohort Study
    Springer Science and Business Media LLC ; 2021
    In:  World Journal of Surgery Vol. 45, No. 9 ( 2021-09), p. 2816-2829
    Details
    In: World Journal of Surgery, Springer Science and Business Media LLC, Vol. 45, No. 9 ( 2021-09), p. 2816-2829
    Abstract: Existing literature suggests deteriorating surgical outcome of esophagogastric surgery as the week progresses. However, these studies were conducted in the pre-centralization and pre-minimally invasive era. In addition, they failed to correct for fixed weekdays of esophagogastric cancer surgery among hospitals. This study aimed to describe the impact of weekday of minimally invasive upper gastrointestinal surgery on short-term surgical outcomes. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit who underwent curative minimally invasive esophageal or gastric carcinoma surgery in 2015–2019, were included in this nationwide cohort study. Using multilevel multivariable logistic regression, the impact of weekday of surgery on 14 short-term surgical outcomes was investigated. To correct for interhospital variance in fixed weekday(s) of surgery multilevel analyses was used. Results were adjusted for patient, tumor, and treatment characteristics using multivariable logistic regression analyses. Results This study included 4,102 patients undergoing minimally invasive upper gastrointestinal surgery (2,968 esophageal cancer and 1,134 gastric cancer patients). Weekday of surgery did not impact postoperative complications, severe postoperative complications, surgical/technical complications, medical complications, anastomotic leakage, complicated postoperative course, failure to rescue, surgical radicality, lymph node yield, 30-day/in-hospital mortality, reinterventions, length of ICU stay, 30-day readmission, and textbook outcome after neither esophageal cancer nor gastric cancer surgery. Conclusions Minimally invasive esophagogastric surgery can be performed safely on all weekdays with respect to short-term surgical outcomes, which is important information for operation room scheduling.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-021-06160-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 1463296-2
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  • 7
    Online Resource
    Online Resource
    Development of a data-driven case-mix adjustment model for comparison of hospital performance in hip fracture care
    Springer Science and Business Media LLC ; 2022
    In:  Archives of Osteoporosis Vol. 17, No. 1 ( 2022-12)
    Details
    In: Archives of Osteoporosis, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2022-12)
    Abstract: To compare hospitals’ hip fracture patient mortality in a quality of care registry, correction for patient characteristics is needed. This study evaluates in 39,374 patients which characteristics are associated with 30 and 90-day mortality, and showed how using these characteristics in a case mix-model changes hospital comparisons within the Netherlands. Purpose Mortality rates after hip fracture surgery are considerable and may be influenced by patient characteristics. This study aims to evaluate hospital variation regarding patient demographics and disease burden, to develop a case-mix adjustment model to analyse differences in hip fracture patients’ mortality to calculate case-mix adjusted hospital-specific mortality rates. Methods Data were derived from 64 hospitals participating in the Dutch Hip Fracture Audit (DHFA). Adult hip fracture patients registered in 2017–2019 were included. Variation of case-mix factors between hospitals was analysed, and the association between case-mix factors and mortality at 30 and 90 days was determined through regression models. Results There were 39,374 patients included. Significant variation in case-mix factors amongst hospitals was found for age ≥ 80 (range 25.8–72.1% p   〈  0.001), male gender (12.0–52.9% p   〈  0.001), nursing home residents (42.0–57.9% p   〈  0.001), pre-fracture mobility aid use (9.9–86.7% p   〈  0,001), daily living dependency (27.5–96.5% p   〈  0,001), ASA-class ≥ 3 (25.8–83.3% p   〈  0.001), dementia (3.6–28.6% p   〈  0.001), osteoporosis (0.0–57.1% p   〈  0.001), risk of malnutrition (0.0–29.2% p   〈  0.001) and fracture types (all p   〈  0.001). All factors were associated with 30- and 90-day mortality. Eight hospitals showed higher and six showed lower 30-day mortality than expected based on their case-mix. Six hospitals showed higher and seven lower 90-day mortality than expected. The specific outlier hospitals changed when correcting for case-mix factors. Conclusions Dutch hospitals show significant case-mix variation regarding hip fracture patients. Case-mix adjustment is a prerequisite when comparing hospitals’ 30-day and 90-day hip fracture patients’ mortality. Adjusted mortality may serve as a starting point for improving hip fracture care.
    Type of Medium: Online Resource
    ISSN: 1862-3522 , 1862-3514
    URL: Article
    DOI: 10.1007/s11657-022-01094-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2253231-6
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  • 8
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    Outcomes After Major Surgical Procedures in Octogenarians: A Nationwide Cohort Study
    Springer Science and Business Media LLC ; 2022
    In:  World Journal of Surgery Vol. 46, No. 10 ( 2022-10), p. 2399-2408
    Details
    In: World Journal of Surgery, Springer Science and Business Media LLC, Vol. 46, No. 10 ( 2022-10), p. 2399-2408
    Abstract: Aging of the worldwide population has been observed, and postoperative outcomes could be worse in elderly patients. This nationwide study assessed trends in number of surgical resections in octogenarians regarding various major surgical procedures and associated postoperative outcomes. Methods All patients who underwent surgery between 2014 and 2018 were included from Dutch nationwide quality registries regarding esophageal, stomach, pancreas, colorectal liver metastases, colorectal cancer, lung cancer and abdominal aortic aneurysms (AAA). For each quality registry, the number of patients who were 80 years or older (octogenarians) was calculated per year. Postoperative outcomes were length of stay (LOS), 30 day major morbidity and 30 day mortality between octogenarians and younger patients. Results No increase in absolute number and proportion of octogenarians that underwent surgery was observed. Median LOS was higher in octogenarians who underwent surgery for colorectal cancer, colorectal liver metastases, lung cancer, pancreatic disease and esophageal cancer. 30 day major morbidity was higher in octogenarians who underwent surgery for colon cancer, esophageal cancer and elective AAA-repair. 30 day mortality was higher in octogenarians who underwent surgery for colorectal cancer, lung cancer, stomach cancer, pancreatic disease, esophageal cancer and elective AAA-repair. Median LOS decreased between 2014 and 2018 in octogenarians who underwent surgery for stomach cancer and colorectal cancer. 30 day major morbidity decreased between 2014 and 2018 in octogenarians who underwent surgery for colon cancer. No trends were observed in octogenarians regarding 30 day mortality between 2014 and 2018. Conclusion No increase over time in absolute number and proportion of octogenarians that underwent major surgery was observed in the Netherlands. Postoperative outcomes were worse in octogenarians.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-022-06642-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1463296-2
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