Abstract
BackgroundEvidence for an association between hospital volume and outcomes for liver surgery is abundant. The current Dutch guideline requires a minimum volume of 20 annual procedures per centre. The aim of this study was to investigate the association between hospital volume and postoperative outcomes using data from the nationwide Dutch Hepato Biliary Audit.MethodsThis was a nationwide study in the Netherlands. All liver resections reported in the Dutch Hepato Biliary Audit between 2014 and 2017 were included. Annual centre volume was calculated and classified in categories of 20 procedures per year. Main outcomes were major morbidity (Clavien–Dindo grade IIIA or higher) and 30‐day or in‐hospital mortality.ResultsA total of 5590 liver resections were done across 34 centres with a median annual centre volume of 35 (i.q.r. 20–69) procedures. Overall major morbidity and mortality rates were 11·2 and 2·0 per cent respectively. The mortality rate was 1·9 per cent after resection for colorectal liver metastases (CRLMs), 1·2 per cent for non‐CRLMs, 0·4 per cent for benign tumours, 4·9 per cent for hepatocellular carcinoma and 10·3 per cent for biliary tumours. Higher‐volume centres performed more major liver resections, and more resections for hepatocellular carcinoma and biliary cancer. There was no association between hospital volume and either major morbidity or mortality in multivariable analysis, after adjustment for known risk factors for adverse events.ConclusionHospital volume and postoperative outcomes were not associated.
Highlights
In an effort to reduce morbidity and mortality after complex surgical procedures, hospital volume has become a frequent subject of debate[1,2,3]
This study aimed to investigate the relationship between hospital volume and postoperative outcomes after liver surgery using data from the nationwide Dutch Hepato Biliary Audit (DHBA) on all hepatobiliary resections performed in the Netherlands
The postoperative course was complicated after 9⋅2 per cent of the 4210 minor liver resections, and major morbidity and mortality rates in these patients were 7⋅8 and 1⋅2 per cent respectively
Summary
In an effort to reduce morbidity and mortality after complex surgical procedures, hospital volume has become a frequent subject of debate[1,2,3]. In the Netherlands, these studies have led to a minimum annual case volume of at least 20 procedures per hospital for these operations. Without extensive evidence, this threshold has been extrapolated to hepatobiliary surgery, including liver resection. The aim of this study was to investigate the association between hospital volume and postoperative outcomes using data from the nationwide Dutch Hepato Biliary Audit. Main outcomes were major morbidity (Clavien–Dindo grade IIIA or higher) and 30-day or in-hospital mortality. Higher-volume centres performed more major liver resections, and more resections for hepatocellular carcinoma and biliary cancer.
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