Combined Hepatopancreaticobiliary Volume and Hepatectomy Outcomes in Hepatocellular Carcinoma Patients at Low-Volume Liver Centers
- 25 February 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 232 (6), 864-871
- https://doi.org/10.1016/j.jamcollsurg.2021.01.017
Abstract
Background The relationship between hospital volume and surgical outcomes is well-established; however, considerable socioeconomic and geographic barriers to high-volume care persist. This study assesses how the overall volume of hepatopancreaticobiliary (HPB) cancer operations impacts outcomes of liver resections (LRs). Study Design The National Cancer Database (2004-2014) was queried for patients who underwent LR for hepatocellular carcinoma. Hospital volume was determined separately for all HPB operations and LRs. Centers were dichotomized as low and high volume based on the median number of operations. The following study cohorts were created: low-volume hospitals (LVHs) for both LRs and HPB operations, mixed-volume hospitals (MVHs) with low-volume LRs but high-volume HPB operations, and high-volume LR hospitals (HVHs) for both LRs and HPB operations. Results Of 7,265 patients identified, 37.5%, 8.8%, and 53.7% were treated at LVHs, MVHs, and HVHs, respectively. On multivariable analysis, patients treated at LVHs had higher 30-day mortality compared with patients treated at HVHs (odds ratio 1.736; p < 0.001). However, patients treated at MVHs experienced 30-day mortality comparable with patients treated at HVHs (odds ratio 0.789; p = 0.318). Similar results were found for positive margin status, prolonged hospital stay, and overall survival. Conclusions LR outcomes at low-volume LR centers that have substantial experience with HPB cancer operations are similar to those at high-volume LR centers. Our results demonstrate that the volume to outcomes curve for HPB operations should be assessed more holistically and that patients can safely undergo liver operations at low-volume LR centers if HPB volume criteria are met.Keywords
This publication has 16 references indexed in Scilit:
- The Hidden Consequences of the Volume PledgeAnnals of Surgery, 2017
- The Global Burden of Cancer 2013JAMA Oncology, 2015
- Low rates of complications for carotid artery stenting are associated with a high clinician volume of carotid artery stenting and aortic endografting but not with a high volume of percutaneous coronary interventionsJournal of Vascular Surgery, 2014
- Failure to rescue as a source of variation in hospital mortality after hepatic surgeryBritish Journal of Surgery, 2014
- The Volume Effect in Liver Surgery—A Systematic Review and Meta-analysisJournal of Gastrointestinal Surgery, 2013
- Who Receives Their Complex Cancer Surgery at Low-Volume Hospitals?Journal of the American College of Surgeons, 2012
- Defining the type of surgeon volume that influences the outcomes for open abdominal aortic aneurysm repairJournal of Vascular Surgery, 2011
- The National Cancer Data Base: A Powerful Initiative to Improve Cancer Care in the United StatesAnnals of Surgical Oncology, 2008
- Clinicopathologic Features and Treatment Trends of Pancreatic Neuroendocrine Tumors: Analysis of 9,821 PatientsJournal of Gastrointestinal Surgery, 2007
- Regional Availability Of High-Volume Hospitals For Major SurgeryHealth Affairs, 2004