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Journal of Gastrointestinal Surgery

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01-10-2008 | ssat plenery presentation

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

Authors: Robert W. Eppsteiner, Nicholas G. Csikesz, Jessica P. Simons, Jennifer F. Tseng, Shimul A. Shah

Published in: Journal of Gastrointestinal Surgery | Issue 10/2008

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.

Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA. Volume and process of care in high-risk cancer surgery. Cancer 2006;106:2476–2481. doi:10.1002/cncr.21888.PubMedCrossRef

Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–2127. doi:10.1056/NEJMsa035205.PubMedCrossRef

Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137. doi:10.1056/NEJMsa012337.PubMedCrossRef

Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 1999;230:404–411. doi:10.1097/00000658-199909000-00013.PubMedCrossRef

Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg 2005;242:540–544.PubMed

McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246–253. doi:10.1097/01.sla.0000259993.17350.3a.PubMedCrossRef

Dimick JB, Stanley JC, Axelrod DA, Kazmers A, Henke PK, Jacobs LA, et al. Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age. Ann Surg 2002;235:579–585. doi:10.1097/00000658-200204000-00017.PubMedCrossRef

Cooper R, Cutler J, Desvigne-Nickens P, Fortmann SP, Friedman L, Havlik R, et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation 2000;102:3137–3147.PubMed

Singh GK, Siahpush M. Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25–64 years by area socioeconomic status, 1969–1998. Int J Epidemiol 2002;31:600–613. doi:10.1093/ije/31.3.600.PubMedCrossRef

10.

Cella DF, Orav EJ, Kornblith AB, Holland JC, Silberfarb PM, Lee KW, et al. Socioeconomic status and cancer survival. J Clin Oncol 1991;9:1500–1509.PubMed

11.

Boxer LK, Dimick JB, Wainess RM, Cowan JA, Henke PK, Stanley JC, et al. Payer status is related to differences in access and outcomes of abdominal aortic aneurysm repair in the United States. Surgery 2003;134:142–145. doi:10.1067/msy.2003.214.PubMedCrossRef

12.

Liu JH, Zingmond DS, McGory ML, SooHoo NF, Ettner SL, Brook RH, Ko CY. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA 2006;296:1973–1980. doi:10.1001/jama.296.16.1973.PubMedCrossRef

13.

Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg 2003;138:721–725. doi:10.1001/archsurg.138.7.721.PubMedCrossRef

14.

Shah SA, Bromberg R, Coates A, Rempel E, Simunovic M, Gallinger S. Survival after liver resection for metastatic colorectal carcinoma in a large population. J Am Coll Surg 2007;205:676–683. doi:10.1016/j.jamcollsurg.2007.06.283.PubMedCrossRef

15.

Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27. doi:10.1097/00005650-199801000-00004.PubMedCrossRef

16.

Li B, Evans D, Faris P, Dean S, Quan H. Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases. BMC Health Serv Res 2008;8:12. doi:10.1186/1472-6963-8-12.PubMedCrossRef

17.

Cochran WG. The effectiveness of adjustment by subclassification in removing bias in observational studies. Biometrics 1968;24:295–313. doi:10.2307/2528036.PubMedCrossRef

18.

Cook EF, Goldman L. Asymmetric stratification. An outline for an efficient method for controlling confounding in cohort studies. Am J Epidemiol 1988;127:626–639.PubMed

19.

Christian CK, Gustafson ML, Betensky RA, Daley J, Zinner MJ. The Leapfrog volume criteria may fall short in identifying high-quality surgical centers. Ann Surg 2003;238:447–455.PubMed

20.

Finlayson SR. The volume-outcome debate revisited. Am Surg 2006;72:1038–1042.PubMed

21.

Metreveli RE, Sahm K, Denstman F, Abdel-Misih R, Petrelli NJ. Hepatic resection at a major community-based teaching hospital can result in good outcome. Ann Surg Oncol 2005;12:133–137. doi:10.1245/ASO.2005.06.007.PubMedCrossRef

22.

Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery 2001;130:415–422. doi:10.1067/msy.2001.117139.PubMedCrossRef

23.

Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997;127:757–763.PubMed

24.

Meguid RA, Ahuja N, Chang DC. What constitutes a “high-volume” hospital for pancreatic resection? J Am Coll Surg. 2008;206:622–629. doi:10.1016/j.jamcollsurg.2007.11.011.PubMedCrossRef

25.

Hannan EL, Popp AJ, Feustel P, Halm E, Bernardini G, Waldman J, et al. Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy. Stroke. 2001;32:2890–2897. doi:10.1161/hs1201.099637.PubMedCrossRef

26.

Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA. Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med. 2006;34:1016–1024. doi:10.1097/01.CCM.0000206105.05626.15.PubMedCrossRef

27.

Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002;288:2151–2162. doi:10.1001/jama.288.17.2151.PubMedCrossRef

28.

Makary MA, Sexton JB, Freischlag JA, Millman EA, Pryor D, Holzmueller C, et al. Patient safety in surgery. Ann Surg 2006;243:628–632. doi:10.1097/01.sla.0000216410.74062.0f.PubMedCrossRef

29.

Olthoff KM, Merion RM, Ghobrial RM, Abecassis MM, Fair JH, Fisher RA, et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg 2005;242:314–323. discussion.PubMed

30.

Quan H, Parsons GA, Ghali WA. Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data. Med Care 2004;42:801–809. doi:10.1097/01.mlr.0000132391.59713.0d.PubMedCrossRef

Title: High Volume and Outcome After Liver Resection: Surgeon or Center?
Authors: Robert W. Eppsteiner
Nicholas G. Csikesz
Jessica P. Simons
Jennifer F. Tseng
Shimul A. Shah
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0627-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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