Abstract

Introduction Standardisation of healthcare has contributed to improved outcomes over recent decades. Management of colorectal cancer and colorectal liver metastasis (CRLM) represents a major healthcare challenge and is a key target of quality measures. This study aimed to assess country-level variation in 90-day mortality following liver resection for CRLM using international data from the LiverMetSurvey, to inform future efforts towards standardisation and improved care. Methods International multicentre data from the LiverMetSurvey were retrieved in March 2023. Patients with CRLM undergoing surgery at their respective centres were included. The primary outcome was 90-day postoperative mortality. Patient demographic and disease-related factors were analysed. To evaluate country-level variation in mortality, the Median Odds Ratio (MOR) and bootstrap-based 95% confidence intervals (c.i.) were calculated, with and without adjustment for confounding variables. Results Data from 30 612 patients across 55 countries were included. Median age at surgery was 63.4 years; 55.4% had systemic comorbidities. Liver resection with curative intent was performed in 94.2% of patients, with complications reported in 6365 (27.2%). Bilateral disease was present in 9665 (38.5%). The unadjusted MOR for 90-day mortality was 2.4, decreasing to 1.55 (95% c.i.: 1.40–1.73) after adjustment. Country-level intrinsic factors explained 4% of the variation, while patient and disease-related factors accounted for 31%. Conclusions Significant variation in CRLM outcomes exists across countries. A relatively large percentage of the variation could be attributed to differences in disease characteristics among patients undergoing surgical treatment implying significant variation in practice.