Factors Related to Textbook Outcome in Laparoscopic Liver Resections: a Single Western Centre Analysis

Abstract Introduction The selection of the most informative quality of care indicator for laparoscopic liver surgery (LLS) is still debated; among those proposed, textbook outcome (TO) seems to provide a compositive measure of the outcomes of surgery. The aim of this study was to investigate the factors related with the TO in a cohort of patients who underwent LLS. Methods Patients who underwent LLS from 2014 to 2021 were included. TO for LLS (TOLLS) was defined as: R0 resection, absence of intraoperative incidents, severe complications, reintervention, 30-day readmission and in-hospital mortality. When also considering no prolonged length of hospital stay (LOS), the outcome was called TOLLS+. Results Four hundred twenty-one patients were included; TOLLS was achieved in 80.5%, TOLLS+ in 60.8% cases. R0 resection was obtained in 90.2% cases, intraoperative incidents occurred in 7.8%, severe complications in 5.0%, reintervention in 0.7%, readmission in 1.4% and in-hospital mortality in 0.2%. 32.5% of patients showed prolonged LOS. After univariate and multivariate analysis, factors influencing TOLLS were age (OR 0.967; p= 0.003), concomitant surgery (OR 0.380; p= 0.003), operative time (OR 0.996; p= 0.008) and blood loss (OR 0.241; p< 0.001); factors influencing TOLLS+ were ASA-score (OR 0.533 ; p= 0.008), tumour histology (OR 0.421; p= 0.021), concomitant surgery (OR 0.293 ; p< 0.001), operative time (OR 0.997; p= 0.016) and blood loss (OR 0.361; p= 0.003). Conclusions TOLLS can be achieved in most patients undergoing LLR, and it seems to be influenced mostly by surgery-related factors; conversely, TOLLS+ is achieved less frequently and seems to be influenced also by patient- and tumour-related factors.