A core set of quality performance indicators for HPB procedures: a global consensus for hepatectomy, pancreatectomy, and complex biliary surgery

Braden Woodhouse, Savio G. Barreto, Kjetil Soreide, Gregor A. Stavrou, Catherine Teh, Henry Pitt, Marcello Di Martino, Paulo Herman, Victor Lopez-Lopez, Frederik Berrevoet, Mark Talamonti, Mikhail Mikhnevich, Igor Khatkov, Laurence Webber, Ayrat Kaldarov, John Windsor, Omero P. Costa Filho, Jonathan Koea, The IHPBA QPI Working Party Membership, Hepatectomy Working GroupPancreatectomy Working Group, Complex Biliary Surgery Working Group, Cholecystectomy Working Group

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Surgery for hepatopancreaticobiliary (HPB) conditions is performed worldwide. This investigation aimed to develop a set of globally accepted procedural quality performance indicators (QPI) for HPB surgical procedures. 

Methods: A systematic literature review generated a dataset of published QPI for hepatectomy, pancreatectomy, complex biliary surgery and cholecystectomy. Using a modified Delphi process, three rounds were conducted with working groups composed of self-nominating members of the International Hepatopancreaticobiliary Association (IHPBA). The final set of QPI was circulated to the full membership of the IHPBA for review. 

Results: Seven “core” indicators were agreed for hepatectomy, pancreatectomy, and complex biliary surgery (availability of specific services on site, a specialised surgical team with at least two certified HPB surgeons, a satisfactory institutional case volume, synoptic pathology reporting, undertaking of unplanned reintervention procedures within 90 days, the incidence of post-procedure bile leak and Clavien-Dindo grade ≥III complications and 90-day post-procedural mortality). Three further procedure specific QPI were proposed for pancreatectomy, six for hepatectomy and complex biliary surgery. Nine procedure-specific QPIs were proposed for cholecystectomy. The final set of proposed indicators were reviewed and approved by 102 IHPBA members from 34 countries. 

Conclusions: This work presents a core set of internationally agreed QPI for HPB surgery.

Original languageEnglish
Pages (from-to)924-932
Number of pages9
JournalHPB: The Official Journal of The IHPBA, EHPBA and AHPBA
Issue number8
Early online date26 Apr 2023
Publication statusPublished - Aug 2023


  • quality performance indicators (QPI)
  • hepatectomy
  • pancreatectomy
  • complex biliary (HPB) surgery
  • cholecystectomy


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