This thesis of Michelle Regina de Graaff explores how care for people with liver cancer in the Netherlands can be improved. At its core is the Dutch Hepato Biliary Audit (DHBA), a nationwide quality registry that has tracked all liver surgeries and certain local treatments since 2013. Thanks to this data source, we can see how care has evolved over time. In recent years, patients undergoing surgery tend to be older and have more additional health problems, yet mortality rates and serious complications have actually gone down. Minimally invasive surgical techniques, which often allow for faster recovery, are also being used more frequently.
A key part of the research looks at how we measure quality of care between hopsitals. The traditional approach does not always give an accurate picture, which is why this dissertation discusses a new measure: the “Textbook Outcome.”
One of the findings in this thesis is the large variation between hospitals in treatment modalities offered to patients. Some hospitals are more likely to give chemotherapy before surgery, combine multiple procedures in a single operation, or use minimally invasive techniques more often. Interestingly, less invasive approaches often prove just as safe and effective. Factors such as which hospital a patient visits first—and even their gender and socioeconomic status—can influence whether they receive surgery at all.
The takeaway is that the DHBA is a powerful tool for revealing differences between hospitals, helping doctors and institutions learn from one another. By collaborating more effectively, reducing unnecessary variations in treatment, and ensuring equal access to high-quality care, liver surgery in the Netherlands can continue to improve.
