The Combined Effects of Hospital and Surgeon Volume on Short-Term Survival after Hepatic Resection in a Population-Based Study

Abstract

BackgroundThe influence of different hospital and surgeon volumes on short-term survival after hepatic resection is not clearly clarified. By taking the known prognostic factors into account, the purpose of this study is to assess the combined effects of hospital and surgeon volume on short-term survival after hepatic resection.Methods13,159 patients who underwent hepatic resection between 2002 and 2006 were identified in the Taiwan National Health Insurance Research Database. Data were extracted from it and short-term survivals were confirmed through 2006. The Cox proportional hazards model was used to assess the relationship between survival and different hospital, surgeon volume and caseload combinations.ResultsHigh-volume surgeons in high-volume hospitals had the highest short-term survivals, following by high-volume surgeons in low-volume hospitals, low-volume surgeons in high-volume hospitals and low-volume surgeons in low-volume hospitals. Based on Cox proportional hazard models, although high-volume hospitals and surgeons both showed significant lower risks of short-term mortality at hospital and surgeon level analysis, after combining hospital and surgeon volume into account, high-volume surgeons in high-volume hospitals had significantly better outcomes; the hazard ratio of other three caseload combinations ranging from 1.66 to 2.08 (p<0.001) in 3-month mortality, and 1.28 to 1.58 (p<0.01) in 1-year mortality.ConclusionsThe combined effects of hospital and surgeon volume influenced the short-term survival after hepatic resection largely. After adjusting for the prognostic factors in the case mix, high-volume surgeons in high-volume hospitals had better short-term survivals. Centralization of hepatic resection to few surgeons and hospitals might improve patients’ prognosis.

Validation of the board certification system for expert surgeons (hepato‐biliary‐pancreatic field) using the data of the National Clinical Database of Japan: part 1 ‐ Hepatectomy of more than one segment

“…Definitions of HVHs and LVHs performing hepatectomy varied between studies. Thresholds defining HVH in the abovementioned studies were 10–100 hepatectomies per year . A multiple logistic regression model showed that the cutoffs of high‐level HBP surgeries performed per year at hospitals that predicted 30‐day mortality and operative mortality after MOS hepatectomies were 10 and 50 in the present study.…”

“…According to the nationwide studies of hepatic surgery, the proportion of high‐volume hospitals (HVHs) among all hospitals and the proportion of cases performed at HVHs were 2.4–10% and 32–75%, respectively . In all these studies except one from the United States , which analyzed data covering approximately 20% of all discharges in the United States, the numbers of HVHs were small: 6–23 hospitals . It may be said that centralization of hepatic surgery in Japan has advanced to a certain degree, though the numbers of HVHs are limited, and centralization has advanced further in some countries.…”

Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

“…However, the detailed analysis of recurrence pattern and the treatment for recurrence would not have been possible using population-based data [12,14]. In addition, although population-based analyses are said to better describe the outcomes achieved in routine practice [14], the trend in centralization of high-risk surgery is associated with improved shortas well as long-term outcomes [32][33][34][35][36][37][38][39][40][41][42]. Considering much better outcomes reported from high-volume liver centers [20,[43][44][45], the results demonstrated in the current study may reflect ideal practice in the near future when centralization is optimized for older patients with CRLMs undergoing hepatectomy.…”

Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

“…However, the detailed analysis of recurrence pattern and the treatment for recurrence would not have been possible using population-based data [12,14]. In addition, although population-based analyses are said to better describe the outcomes achieved in routine practice [14], the trend in centralization of high-risk surgery is associated with improved short-as well as long-term outcomes [32][33][34][35][36][37][38][39][40][41][42]. Considering much better outcomes reported from high-volume liver centers [20,[43][44][45], the results demonstrated in the current study may re ect ideal practice in the near future when centralization is optimized for older patients with CRLMs undergoing hepatectomy.…”