Textbook outcome in hepato-pancreato-biliary surgery: systematic review

Background Textbook outcome (TO) is a multidimensional measure reflecting the ideal outcome after surgery. As a benchmarking tool, it provides an objective overview of quality of care. Uniform definitions of TO in hepato-pancreato-biliary (HPB) surgery are missing. This study aimed to provide a definition of TO in HPB surgery and identify obstacles and predictors for achieving it. Methods A systematic literature search was conducted using PubMed, Embase, and Cochrane Database according to PRISMA guidelines. Studies published between 1993 and 2021 were retrieved. After selection, two independent reviewers extracted descriptive statistics and derived summary estimates of the occurrence of TO criteria and obstacles for achieving TO using co-occurrence maps. Results Overall, 30 studies were included. TO rates ranged between 16-69 per cent. Commonly chosen co-occurring criteria to define TO included 'no prolonged length of stay (LOS)', 'no complications', 'no readmission', and 'no deaths'. Major obstacles for achieving TO in HPB surgery were prolonged LOS, complications, and readmission. On multivariable analysis, TO predicted better overall and disease-free survival in patients with cancer. Achievement of TO was more likely in dedicated centres and associated with procedural and structural indicators, including high case-mix index and surgical volume. Conclusion TO is a useful quality measure to benchmark surgical outcome. Future definitions of TO in HPB surgery should include 'no prolonged LOS', 'no complications', 'no readmission', and 'no deaths'. Textbook outcome (TO) reflects the ideal outcome after surgery and is a useful quality measure to benchmark surgical outcome. We are the first to propose a uniform definition of TO in hepato-pancreato-biliary surgery, including 'no prolonged length of stay', 'no complications', 'no readmission', and 'no mortality'.

Automated summary

Background: Textbook outcome (TO) is a multidimensional measure reflecting the ideal outcome after surgery. TO is a useful quality measure to benchmark surgical outcome. However, there is a lack of uniform definitions of TO in hepato-pancreato-biliary (HPB) surgery. This study aimed to provide a definition of TO in HPB surgery and identify obstacles and predictors for achieving it.