Textbook Outcome in Liver Surgery (TOLS) Calculator
Textbook outcome in Liver Surgery (TOLS) is a novel composite measure with an "all or none concept". TOLS combines the most desirable postoperative outcomes after liver surgery into one single measure and embodies the “ideal” postoperative course. It consists of the absence of intraoperative grade ≥ 2 incidents, postoperative bile leak of grade B/C, postoperative liver failure grade B/C, 90-day major postoperative complications, 90-day readmission due to surgery related major complications, 90-day/in-hospital mortality and the presence of R0 resection margin. If a patient meets all 7 desirable postoperative outcomes, TOLS is achieved. The current calculator may aid clinical practie to calculate TOLS for the individual patient following liver surgery.
Research authors: Burak Görgec, Mohammad Abu Hilal
Version: 1.57
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The patient meets out of 7 surgical variables within the TOLS definition

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Conditional information

- Intraoperative incidents as described in the Oslo classification:

Grade I:

  • Incidents managed without change in operative approach and without further consequences for the patient. This includes minor injury to adherent or adjacent organs and minimal change to intraoperative tactics and procedures with blood loss over the normal range. (e.g. blood loss over 775 ml)
Grade II:
  • Incidents with further consequences for the patient. This includes patients requiring limited resection of organs injured during surgery. For laparoscopic surgery, it includes intraoperative incidents requiring conversion to open operation
Grade III:
  • Incident leading to significant consequences for the patient

 - Grading of severity of bile leakage as described by the International Study group of Liver Surgery:

Grade A:
  • Bile leakage causes no change in patients’ clinical management
Grade B:
  • Bile leakage requires active therapeutic intervention but is manageable without relaparotomy
Grade C:
  • Bile leakage relaparotomy is required

 - Grading of severity of posthepatectomy liver failure as described by the International Study group of Liver Surgery:

Grade A:
  • Posthepatectomy liver failure requires no change of the patient's clinical management.
Grade B:
  • The clinical management of patient deviates from the regular course but does not require invasive therapy.
Grade C:
  • Posthepatectomy liver failure needs invasive treatment.


 

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This model is provided for educational, training and information purposes. It must not be used to support medical decision making, or to provide medical or diagnostic services. Read our full disclaimer.

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