ssat plenery presentation

Journal of Gastrointestinal Surgery

, Volume 12, Issue 10, pp 1709-1716

First online:

High Volume and Outcome After Liver Resection: Surgeon or Center?

  • Robert W. EppsteinerAffiliated withDepartment of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School
  • , Nicholas G. CsikeszAffiliated withDepartment of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School
  • , Jessica P. SimonsAffiliated withDepartment of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School
  • , Jennifer F. TsengAffiliated withDepartment of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School
  • , Shimul A. ShahAffiliated withDepartment of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical SchoolDivision of Organ Transplantation, Surgical Outcomes Analysis & Research, Department of Surgery, University of Massachusetts Medical School Email author 

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Abstract

Introduction

In a case controlled analysis, we attempted to determine if the volume–survival benefit persists in liver resection (LR) after eliminating differences in background characteristics.

Methods

Using the Nationwide Inpatient Sample (NIS), we identified all LR (n = 2,949) with available surgeon/hospital identifiers performed from 1998–2005. Propensity scoring adjusted for background characteristics. Volume cut-points were selected to create equal groups. A logistic regression for mortality was then performed with these matched groups.

Results

At high volume (HV) hospitals, patients (n = 1423) were more often older, white, private insurance holders, elective admissions, carriers of a malignant diagnosis, and high income residents (p < 0.05). Propensity matching eliminated differences in background characteristics. Adjusted in-hospital mortality was significantly lower in the HV group (2.6% vs. 4.8%, p = 0.02). Logistic regression found that private insurance and elective admission type decreased mortality; preoperative comorbidity increased mortality. Only LR performed by HV surgeons at HV centers was independently associated with improved in-hospital mortality (HR, 0.43; 95% CI, 0.22–0.83).

Conclusions

A socioeconomic bias may exist at HV centers. When these factors are accounted for and adjusted, center volume does not appear to influence in-hospital mortality unless LR is performed by HV surgeons at HV centers.

Keywords

Liver resection NIS Propensity scores Mortality Volume