OBJECTIVE: The objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC). METHODS: This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test. RESULTS: The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001). CONCLUSIONS: The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.
OBJECTIVE: The objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC). METHODS: This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test. RESULTS: The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001). CONCLUSIONS: The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.
Authors: Ch Tschuor; K P Croome; G Sergeant; V Cano; E Schadde; V Ardiles; K Slankamenac; R S Clariá; E de Santibaňes; R Hernandez-Alejandro; P-A Clavien Journal: Eur J Surg Oncol Date: 2013-08-29 Impact factor: 4.424
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Authors: Rie Sakai-Bizmark; Laurie A Mena; Hiraku Kumamaru; Ichiro Kawachi; Emily H Marr; Eliza J Webber; Hyun H Seo; Scott I M Friedlander; Ruey-Kang R Chang Journal: Health Serv Res Date: 2019-03-27 Impact factor: 3.402
Authors: Maria S Altieri; Jie Yang; Donglei Yin; Catherine Frenkel; Mark Talamini; Dana A Telem; Aurora Pryor Journal: Surg Endosc Date: 2016-11-04 Impact factor: 4.584
Authors: Katherine R Iverson; Emma Svensson; Kristin Sonderman; Ernest J Barthélemy; Isabelle Citron; Kerry A Vaughan; Brittany L Powell; John G Meara; Mark G Shrime Journal: Int J Health Policy Manag Date: 2019-09-01