Optimization of Health Expenditure in Liver Surgery

• overall postoperative length of stay [ Time Frame: during the 3 months after the surgery ]

  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.

  
  

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

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