Optimization of Health Expenditure in Liver Surgery

Study Overview
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Brief Summary
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The aim of this study is to reduce the length of stay after liver surgery by taking account of objective quantitative clinical variables, subjective qualitative clinical variables and non clinical variables.

Detailed Description
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a new dimension of the activity expected of physicians is to improve the safety of care on the one hand and the control of health care costs on the other. key measures to help them are the publication of national recommendations, assessment of actual practices and the incentive to activity. Internationalwide recent and concordant data suggest that quality and security of care, after an initial improvement, are going to stall scientific recommendations are rarely validated by an impact analysis and are not applied clinical data collected within an administrative framework are unreliable and too generalist the evaluation, especially in the surgical field, is based on indicators sometimes irrelevant and often unclear

Official Title
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Optimization of Health Expenditure in Major Surgery: Impact of a Mixed, Clinical and Ethnographic Approach in the Model of Liver Surgery

Conditions
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Hepatocellular Carcinoma, Hilar Cholangiocarcinoma, Intra Hepatic Cholangiocarcinoma, Liver Metastasis

Intervention / Treatment
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* Procedure: liver surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: elective liver surgery older than 18 agreed to participate surgical procedure included procedures registered as HLFA003 - 007 ; 009 - 011 ; 017 - 020 ; HLFC002 à 004 ; 027 ; 032 ; 037 in the PMSI database Exclusion Criteria: emergency surgery refused to participate

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| operated patients<br>this cohort includes patients who underwent a liver surgery whatever the pathology and whatever the surgical procedure | Procedure: liver surgery<br>* this intervention type includes hepatectomies; wedge; segmentectomies etc...<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| overall postoperative length of stay | the overall postoperative length of stay is defined as the hospitalization between the surgery and patient's discharge. This period includes the readmission for at least 24 hours in case of outcomes related to the surgery. | during the 3 months after the surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| peroperative outcomes | the peroperative outcomes are collected during the surgery and correspond to any event occured during the surgical intervention | during the surgical procedure | 
| postoperative outcomes | the postoperative outcomes correspond to any event occured after the surgical intervention. These outcomes include fistulae; bleeding... | after the surgery until postoperative month 3 | 
| construct of pronostic models | the construct of pronostic models include variables that affect the length of stay; morbidity and mortality | after the postoperative month 3 | 
| evaluation of PMSI indicators | this evaluation includes the analysis of PMSI indicators; their validity and the influence of centres on hepatectomies results | after the postoperative month 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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liver tumor, carcinoma, cholangiocarcinoma, metastasis