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The Relationship Between Hospital Volume and Outcomes of Hepatic Resection for Hepatocellular Carcinoma
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.
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