Facility Volume Thresholds for Optimization of Short- and Long-Term Outcomes in Patients Undergoing Hepatectomy for Primary Liver Tumors.
Publication/Presentation Date
2-1-2023
Abstract
BACKGROUND: Volume-outcome relationships have been described for a variety of surgical procedures. We aimed to define the facility volume threshold at which postoperative mortality after hepatectomy was optimal.
METHODS: We determined volume percentiles for institutions performing hepatectomy for any primary liver tumor within the National Cancer Database (2004-2017). Marginal structural logistic regression defined the volume percentile (Vmin) at which the odds of 90-day mortality were optimally reduced in patients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC). Short-term postoperative and survival outcomes were compared between patients treated at facilities above and below Vmin.
RESULTS: Thresholds for the 10
CONCLUSIONS: Resection of HCC and ICC is performed at a large number of facilities. Postoperative mortality is optimally reduced at facilities performing at least 46 liver operations annually. Regionalization of surgical care among patients with primary liver malignancies to high-volume centers may result in improved outcomes.
Volume
27
Issue
2
First Page
273
Last Page
282
ISSN
1873-4626
Published In/Presented At
Hoerger, K., Hue, J. J., Elshami, M., Ammori, J. B., Hardacre, J. M., Winter, J. M., & Ocuin, L. M. (2023). Facility Volume Thresholds for Optimization of Short- and Long-Term Outcomes in Patients Undergoing Hepatectomy for Primary Liver Tumors. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 27(2), 273–282. https://doi.org/10.1007/s11605-022-05541-4
Disciplines
Medicine and Health Sciences
PubMedID
36443556
Department(s)
Department of Surgery, Lehigh Valley Topper Cancer Institute
Document Type
Article