Abstract
The aim of this study was to assess whether the case volume of surgeons and hospitals affects the rates of postoperative complications and survival after liver transplantation. This population-based retrospective cohort study included 2938 recipients of liver transplantation performed between 1998 and 2012, enrolled from the Taiwan National Health Insurance Research Database. They were divided into two groups, according to the cumulative case volume of their operating surgeons and the case volume of their hospitals. The duration of intensive care unit stay and post-transplantation hospitalization, postoperative complications, and mortality were analyzed. The results showed that, in the low and high case volume surgeons groups, respectively, acute renal failure occurred at the rate of 14.11% and 5.86% (p<0.0001), and the overall mortality rates were 19.61% and 12.44% (p<0.0001). In the low and high case volume hospital groups, respectively, acute renal failure occurred in 11% and 7.11% of the recipients (p = 0.0004), and the overall mortality was 18.44% and 12.86% (p<0.0001). These findings suggest that liver transplantation recipients operated on higher case volume surgeons or in higher case volume hospitals have a lower rate of acute renal failure and mortality.
Highlights
Nowadays, liver transplantation is performed to treat for a variety of liver diseases such as acute hepatic failure, cholestatic disease, congenital biliary disease, cirrhosis, liver tumors, and metabolic diseases [1, 2]
Recipients operated on by low case volume surgeons stayed in the intensive care unit (ICU) for a longer period than those operated on by high case volume surgeons (p
Patients who encountered acute renal failure after liver transplantation had increased mortality rates [13, 23]. Consistent with these findings, our study found that liver transplantation recipients operated on by high case volume surgeons or operated in high case volume hospitals have a lower rate of acute renal failure and mortality
Summary
Liver transplantation is performed to treat for a variety of liver diseases such as acute hepatic failure, cholestatic disease, congenital biliary disease, cirrhosis, liver tumors, and metabolic diseases [1, 2]. The experience of the doctors or the care teams may be an important factor affecting the outcomes of complex surgical procedures. Better outcomes were reported for patients treated in high -volume hospitals and by high -volume colorectal specialists [3, 4]. Lower 1-year mortality was observed in higher volume hospitals [5, 6]. Perioperative complications were lower with high -volume surgeons and at high -volume centers after adult spinal deformity revision surgery [7].
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