This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (82)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Hepatobiliary Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

Robert E. Glasgow, MD; Jonathan A. Showstack, PhD, MPH; Patricia P. Katz, PhD; Carlos U. Corvera, MD; Robert S. Warren, MD; Sean J. Mulvihill, MD

Arch Surg. 1999;134:30-35.

Background  Volume-outcome relations have been established for several complex therapies. However, few studies have examined volume-outcome relations for high-risk procedures in general surgery, such as hepatectomy for hepatocellular carcinoma (HCC).

Objective  To evaluate the relation between hospital volume and outcome for patients undergoing hepatectomy for HCC.

Design  Retrospective cohort study.

Setting  All acute-care hospitals in California.

Patients  Hospital discharge data were analyzed for each patient in California who underwent major hepatic resection for HCC from January 1, 1990, through December 31, 1994. Hospitals were grouped according to number of hepatectomies performed at each center during the 5-year study.

Main Outcome Measures  Outcome measures included operative mortality and length of hospital stay. Regression analyses were used to adjust for differences in patient mix.

Results  Five hundred seven patients underwent hepatectomy for HCC during the study. Hepatic resections were performed in 138 hospitals, with an overall in-hospital mortality rate of 14.8%. Three quarters of patients were treated at hospitals that average 3 or fewer hepatic resections for HCC per year. These low-volume providers represent 97.1% of all hospitals treating patients with HCC statewide. Significant reductions in risk-adjusted operative mortality rates (22.7%-9.4%; P=.002, multiple logistic regression) and risk-adjusted length of stay (14.3-11.3 days; P=.03, multiple linear regression) were observed as hospital volume increased.

Conclusions  Low operative mortality and length of stay were associated with high-volume centers. These data support regionalization of high-risk procedures in general surgery, such as hepatectomy for HCC.

From the Departments of Surgery (Drs Glasgow, Corvera, Warren, and Mulvihill) and Medicine (Drs Showstack and Katz) and the Institute for Health Policy Studies (Drs Showstack and Katz), University of California, San Francisco.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Invited Critique: The Relationship Between Hospital Volume and Outcomes of Hepatic Resection for Hepatocellular Carcinoma
Christian Herfarth and Peter Kienle
Arch Surg. 1999;134(1):35.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Long-term Survival After Surgery for Primary Hepatic Sarcoma in Adults
Matthaei et al.
Arch Surg 2009;144:339-344.
ABSTRACT | FULL TEXT  

Patient characteristics and hospital quality for colorectal cancer surgery
Zhang et al.
Int J Qual Health Care 2007;19:11-20.
ABSTRACT | FULL TEXT  

The Relationship Between Surgeon and Hospital Volume and Outcomes for Shoulder Arthroplasty
Jain et al.
JBJS 2004;86:496-505.
ABSTRACT | FULL TEXT  

The Effect of Clustering of Outcomes on the Association of Procedure Volume and Surgical Outcomes
Panageas et al.
ANN INTERN MED 2003;139:658-665.
ABSTRACT | FULL TEXT  

Hospital Volume and Operative Mortality in Cancer Surgery: A National Study
Finlayson et al.
Arch Surg 2003;138:721-725.
ABSTRACT | FULL TEXT  

Hepatic Resection in the United States: Indications, Outcomes, and Hospital Procedural Volumes From a Nationally Representative Database
Dimick et al.
Arch Surg 2003;138:185-191.
ABSTRACT | FULL TEXT  

Postoperative Complication Rates After Hepatic Resection in Maryland Hospitals
Dimick et al.
Arch Surg 2003;138:41-46.
ABSTRACT | FULL TEXT  

Implementation of a Voluntary Hospitalist Service at a Community Teaching Hospital: Improved Clinical Efficiency and Patient Outcomes
Auerbach et al.
ANN INTERN MED 2002;137:859-865.
ABSTRACT | FULL TEXT  

The Effect of ICU Physician Staffing and Hospital Volume on Outcomes After Hepatic Resection
Dimick et al.
J Intensive Care Med 2002;17:41-47.
ABSTRACT  

Surgical volume was not related to 30 day mortality in 8 common operations
Birkmeyer
Evid. Based Med. 2000;5:62-62.
FULL TEXT