Hepatic resection has become common in the United States for both primary and secondary hepatic tumors.
Variation in outcome after hepatic resection relates to patient characteristics, the indication for operation, and hospital procedural volume.
To investigate outcome variation researchers performed an observational study using a nationally representative database. They included 2097 patients in the Nationwide Inpatient Sample for 1996 and 1997, who had undergone hepatic resection.
Outcomes measured included in-hospital mortality, and length of hospital stay.
- high-volume hospitals = 4%
- low-volume hospitals = 8%
|Archives of Surgery|
The team performed risk-adjusted analyses using hierarchical multivariate models.
The research team determined that overall mortality for the 2097 patients was 6%.
They identified the most common indications for hepatic resection as secondary metastases (52%), primary hepatic malignancy (16%), biliary tract malignancy (10%), and benign hepatic tumor (5%).
The team found that high-volume hospitals had a mortality rate of 4%, compared to 8% at low-volume hospitals.
The multivariate analysis adjusting for patient case-mix, high-volume hospitals had a 40% lower risk of in-hospital mortality, compared with low-volume hospitals (odds ratio, 0.60).
The team also identified other predictors of mortality as age older than 65 years, hepatic lobectomy, primary hepatic malignancy, and the severity of underlying liver disease.
Dr Justin Dimick’s team concluded, “Hospital procedural volume is an important predictor of mortality after hepatic resection”.
“Patients who require resection of primary and secondary liver tumors should be offered referral to a high-volume center.”