Faiz Gani1, Daniel Azoulay2, Timothy M Pawlik3,4. 1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Department of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Unite ISERM 955, Creteil, France. 3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tim.pawlik@osumc.edu. 4. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center at The Ohio State University, 395 W. 12th Avenue, Suite 670, Columbus, OH, 43210, USA. tim.pawlik@osumc.edu.
Abstract
INTRODUCTION: Data evaluating trends in hospital volume are lacking. The current study sought to examine trends in outcomes relative to hospital volume following liver surgery. METHODS: A total of 14,296 patients >18 years undergoing an elective liver resection (LR) for cancer were identified using the National Inpatient Sample from 2001 to 2011. Multivariable logistic regression analysis was performed to compare postoperative morbidity and mortality relative to hospital volume over time. RESULTS: Over time, the proportion of patients undergoing a LR at a high-volume hospital (HVH) increased from 24.4 to 45.0 %, while the proportion of patients undergoing a LR at a low-volume hospital (LVH) decreased from 40.4 to 22.7 %. On multivariable analysis, patients undergoing a LR at high-volume hospitals demonstrated a 29 % lower odds of mortality (OR = 0.71, 95 % CI = 0.59-0.86, p < 0.001) compared with patients undergoing a LR at a LVH. The rate of regionalization, however, was not equal among all patients as older patients, patients belonging to a racial minority, and those presenting with substantial comorbidity were less likely to undergo a LR at a HVH. CONCLUSION: An increase in the regionalization of liver surgery was observed over time. Trends in regionalization were, however, associated with discrepancies in access to HVH among specific patient populations.
INTRODUCTION: Data evaluating trends in hospital volume are lacking. The current study sought to examine trends in outcomes relative to hospital volume following liver surgery. METHODS: A total of 14,296 patients >18 years undergoing an elective liver resection (LR) for cancer were identified using the National Inpatient Sample from 2001 to 2011. Multivariable logistic regression analysis was performed to compare postoperative morbidity and mortality relative to hospital volume over time. RESULTS: Over time, the proportion of patients undergoing a LR at a high-volume hospital (HVH) increased from 24.4 to 45.0 %, while the proportion of patients undergoing a LR at a low-volume hospital (LVH) decreased from 40.4 to 22.7 %. On multivariable analysis, patients undergoing a LR at high-volume hospitals demonstrated a 29 % lower odds of mortality (OR = 0.71, 95 % CI = 0.59-0.86, p < 0.001) compared with patients undergoing a LR at a LVH. The rate of regionalization, however, was not equal among all patients as older patients, patients belonging to a racial minority, and those presenting with substantial comorbidity were less likely to undergo a LR at a HVH. CONCLUSION: An increase in the regionalization of liver surgery was observed over time. Trends in regionalization were, however, associated with discrepancies in access to HVH among specific patient populations.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: John E Scarborough; Ricardo Pietrobon; Bryan M Clary; Carlos E Marroquin; Kyla M Bennett; Paul C Kuo; Theodore N Pappas Journal: J Am Coll Surg Date: 2008-08-30 Impact factor: 6.113
Authors: Faiz Gani; Fabian M Johnston; Howard Nelson-Williams; Marcelo Cerullo; Mary E Dillhoff; Carl R Schmidt; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2017-06-29 Impact factor: 3.452
Authors: Eliza W Beal; Rittal Mehta; J Madison Hyer; Anghela Paredes; Katiuscha Merath; Mary E Dillhoff; Jordan Cloyd; Aslam Ejaz; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2019-02-27 Impact factor: 3.452
Authors: Marcelo Cerullo; Sophia Y Chen; Mary Dillhoff; Carl Schmidt; Joseph K Canner; Timothy M Pawlik Journal: JAMA Surg Date: 2017-09-20 Impact factor: 14.766
Authors: J Madison Hyer; Joal D Beane; Gaya Spolverato; Diamantis I Tsilimigras; Adrian Diaz; Alessandro Paro; Djhenne Dalmacy; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2021-09-10 Impact factor: 3.452
Authors: Christian Krautz; Christine Gall; Olaf Gefeller; Ulrike Nimptsch; Thomas Mansky; Maximilian Brunner; Georg F Weber; Robert Grützmann; Stephan Kersting Journal: BMC Surg Date: 2020-07-29 Impact factor: 2.102
Authors: Gilton Marques Fonseca; Vagner Birk Jeismann; Jaime Arthur Pirola Kruger; Fabricio Ferreira Coelho; Andre Luis Montagnini; Paulo Herman Journal: Arq Bras Cir Dig Date: 2018-06-21