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.
Highlights
The discussion about the association between volume and mortality after the high-risk surgical procedures is ongoing
Numerous studies have explored the association between surgeon volume and mortality for certain procedures [3,4,5,6], but few addressed on the relationship between surgeon volume for hepatic resection and short-term mortality [7,8,9]
Due to donor shortage remains a main problem in Asia, hepatic resection being considered the first line curative methods for some patients with hepatocellular carcinoma (HCC) [12,13]
Summary
The discussion about the association between volume and mortality after the high-risk surgical procedures is ongoing. Numerous studies have explored the association between surgeon volume and mortality for certain procedures [3,4,5,6], but few addressed on the relationship between surgeon volume for hepatic resection and short-term mortality [7,8,9]. Most volume-outcome relationship studies explored the association between the two at hospital or surgeon level. The 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
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