Symptom relief and quality of life after combined partial hepatectomy and cyst fenestration in highly symptomatic polycystic liver disease.

BACKGROUND: Polycystic liver disease can cause severe symptomatic hepatomegaly. Combined partial hepatectomy and cyst fenestration can be performed to reduce liver volume and symptom burden. We aimed to assess change in symptom relief and quality of life 6 months after partial hepatectomy and cyst fenestration in polycystic liver disease patients. METHOD: We established a prospective cohort between 2014 and 2018 at a referral center in the United States. Patients who underwent partial hepatectomy and cyst fenestration for volume-related symptoms were included. Primary outcome was change in polycystic liver disease-related symptoms, measured with Polycystic Liver Disease Questionnaire. Secondary outcomes were change in liver volume (computed tomography/ magnetic resonance imaging) and change in quality of life, measured with the 12-Item Short Form Survey and the EuroQoL Visual Analogue Scale. Questionnaire scores range from 0 to 100 and were assessed before and 6 months after partial hepatectomy and cyst fenestration. Surgical complications were scored according to Clavien-Dindo (grade 1 to 5). RESULTS: We included 18 patients (mean age 52 years, 82% female). Partial hepatectomy and cyst fenestration reduced median liver volume (4,917 to 2,120 mL). Symptoms, measured with Polycystic Liver Disease Questionnaire, decreased (76.9 to 34.8 points; P < .001) 6 months after surgery; 15/16 symptoms declined after treatment, with the most impact seen on early satiety and dyspnea. Quality of life also improved after surgery: median physical and mental component scales of the 12-Item Short Form Survey and EuroQoL Visual Analog Scale increased (24.9 to 45.7, P = .004; 40.5 to 55.4, P = .02; and 40.0 to 72.5, P = .003). Major complications (grade 4) occurred in 2 patients. There was no procedure-related mortality. CONCLUSION: Partial hepatectomy and cyst fenestration substantially improves symptom burden and quality of life in highly symptomatic polycystic liver disease patients.

Patient safety first... a California partnership for health.

BACKGROUND: In California in 2009, Anthem Blue Cross joined forces with three regional hospital associations (RHAs) and an independent evaluator in an initial three-year, $6-million effort to address patient safety. METHODS: During Phase 1 of the Patient Safety First... a California Partnership for Health program (2010-2012), more than 180 of the 395 hospitals represented by the RHAs shared and implementated best practices in learning collaboratives. The three initial areas of focus were (1) health care-associated infections-ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI); (2) sepsis mortality; and (3) perinatal care-reduction of elective deliveries prior to 39 weeks of gestation. To measure progress, the difference in the average rates from 2009 (baseline) to 2012 was calculated using data from hospitals that reported for every quarter from 2009 through 2012. RESULTS: The rate decreases-57% for VAP cases per 1,000 ventilator-days, 43% for CLABSI cases per 1,000 central line-days, 24% reduction for CAUTI cases per 1,000 patient-days, 26% reduction for sepsis deaths per 100 sepsis cases, and 74% for elective deliveries < 39 gestational weeks-were statistically significant at the .05 level, except for CAUTI. A cost-avoidance analysis showed that these reductions were associated with a saving of 3,576 lives and an avoidance of $63.8 million in costs statewide (not limited to Anthem Blue Cross members). CONCLUSION: The Patient Safety First program provides a long-term opportunity for collaboration among different health care sectors to share best practices to improve health care for Californians. Phase 2 will continue to addresssepsis and elective deliveries and add other initiatives.