Journal of Gastrointestinal Surgery

, Volume 17, Issue 11, pp 1984–1996 | Cite as

The Volume Effect in Liver Surgery—A Systematic Review and Meta-analysis

  • Arthur J. Richardson
  • Tony C. Y. Pang
  • Emma Johnston
  • Michael J. Hollands
  • Vincent W. T. Lam
  • Henry C. C. Pleass
Review Article



There is an inverse relationship between hospital and surgeon volume and mortality in many types of complex surgery. The aim of this paper is to investigate the volume effect on outcomes of liver surgery.


A systematic review and meta-analysis was performed. A literature search was conducted using Medline and EMBASE from 1995 to 2012. A random effects model was used.


Seventeen studies were selected for detailed analysis. Definition of a high-volume institution varied from 2 to more than 33 procedures per year. The pooled odds ratio of mortality rate in low- vs high-volume centres was 2.0 [95 % confidence interval (CI), 1.6–2.4; P < 0.001]. Some studies divided centres into more than two groups and compared the highest and lowest volume groups. The pooled odds ratio of mortality rate for this comparison type was 3.2 (95 % CI, 1.7–5.8; P < 0.001). Funnel plots suggest possible publication bias. There was inadequate data to compare morbidity. Only two of seven studies demonstrated a shorter length of stay in the high-volume centres. There was no convincing volume effect on long-term survival.


This study suggests a strong relationship between volume and perioperative mortality. No difference in morbidity, length of stay or survival was demonstrated.


Liver surgery Hepatectomy Morbidity Mortality Cancer surgery Regionalisation High volume 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Arthur J. Richardson
    • 1
    • 2
    • 3
  • Tony C. Y. Pang
    • 1
    • 2
  • Emma Johnston
    • 1
    • 2
  • Michael J. Hollands
    • 1
    • 2
  • Vincent W. T. Lam
    • 1
    • 2
  • Henry C. C. Pleass
    • 1
    • 2
  1. 1.Department of Surgery, Westmead HospitalUniversity of SydneySydneyAustralia
  2. 2.Discipline of SurgerySydney Medical SchoolSydneyAustralia
  3. 3.Department of SurgeryWestmead HospitalWentworthvilleAustralia

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