 |
|
Postoperative Complication Rates After Hepatic Resection in Maryland Hospitals
Justin B. Dimick, MD;
Peter J. Pronovost, MD, PhD;
John A. Cowan, Jr, MD;
Pamela A. Lipsett, MD
Arch Surg. 2003;138:41-46.
Hypothesis High-volume centers provide superior quality care and therefore have a lower incidence of postoperative complications.
Design Observational statewide administrative database.
Setting State of Maryland, nonfederal acute-care hospital (n = 52), performing liver resection (n = 35).
Patients All patients discharged after undergoing hepatic resection from 1994 to 1998 (N = 569).
Main Outcome Measures Two sequential analyses using multiple logistic regression of in-hospital mortality were performed to determine the relative importance of preoperative case-mix and postoperative complications.
Results The overall in-hospital mortality rate was 4.8% and was significantly lower in high-volume hospitals (2.8%) than in low-volume hospitals (10.2%) (P<.001). After adjusting for case-mix in the multivariate analysis, low hospital volume was associated with a 3-fold increase in mortality (odds ratio, 3.1; 95% confidence interval [CI], 1.2-7.6; P = .02). Having surgery at a low-volume hospital was associated with increased rates of several postoperative complications: reintubation (relative risk [RR], 2.5; 95% CI, 1.8-3.4), pulmonary failure (RR, 2.3; 95% CI, 1.6-3.5), pneumonia (RR, 0.35; 95% CI, 1.0-5.6), acute renal failure (RR, 2.0; 95% CI, 1.1-3.7), acute myocardial infarction (RR, 2.6; 95% CI, 1.2-5.9), and aspiration (RR, 1.4; 95% CI, 0.9-2.0). When considering all other factors using statistical methods, hospital volume was no longer associated with mortality.
Conclusions Patients who undergo hepatic resection at low-volume hospitals are at a higher risk of postoperative complications and death than those who have the same operation at high-volume hospitals. The empirical difference between outcomes at high- and low-volume hospitals seems to be due to a variation in postoperative complications.
From the Department of Surgery, University of Michigan, Ann Arbor (Drs Dimick and Cowan); the Departments of Surgery, Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Pronovost and Lipsett); and the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Hygiene and Public Health, Baltimore (Dr Provonost).
RELATED ARTICLE
This Month in Archives of Surgery
Arch Surg. 2003;138(1):6.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Complications Following Bilateral Prophylactic Mastectomy
Barton et al.
J Natl Cancer Inst Monogr 2005;2005:61-66.
ABSTRACT
| FULL TEXT
Hepatic Resection at a Major Community-Based Teaching Hospital Can Result in Good Outcome
Metreveli et al.
Ann. Surg. Oncol. 2005;12:133-137.
ABSTRACT
| FULL TEXT
|
