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28-11-2022 | Cholangiocarcinoma | Original Article

Facility Volume Thresholds for Optimization of Short- and Long-Term Outcomes in Patients Undergoing Hepatectomy for Primary Liver Tumors

Authors: Kelly Hoerger, Jonathan J. Hue, Mohamedraed Elshami, John B. Ammori, Jeffrey M. Hardacre, Jordan M. Winter, Lee M. Ocuin

Published in: Journal of Gastrointestinal Surgery | Issue 2/2023

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^th/25^th/50^th/75^th/90^th percentiles were 2/7/26/46/59 hepatectomies/year. A total of 17,833 patients underwent resection of HCC or ICC. The 90-day postoperative mortality was optimized at the 75^th percentile for all hepatectomies (IP-weighted OR = 0.67, 95% CI = 0.52–0.87) and major hepatectomy (IP-weighted OR = 0.62, 95% CI = 0.49–0.80). Seven of 446 facilities met the Vmin threshold. The odds of 30-day mortality were also reduced for all hepatectomies (IP-weighted OR = 0.55, 95% CI = 0.42–0.73) and major hepatectomy (IP-weighted OR = 0.58, 95% CI = 0.41–0.75). There were no differences in length of stay or 30-day readmission rate. Patients with HCC or ICC treated at facilities ≥ 10^th percentile had an associated improvement in overall survival.

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.

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Title: Facility Volume Thresholds for Optimization of Short- and Long-Term Outcomes in Patients Undergoing Hepatectomy for Primary Liver Tumors
Authors: Kelly Hoerger
Jonathan J. Hue
Mohamedraed Elshami
John B. Ammori
Jeffrey M. Hardacre
Jordan M. Winter
Lee M. Ocuin
Publication date: 28-11-2022
Publisher: Springer US
Keywords: Cholangiocarcinoma
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Cholangiocarcinoma
Published in: Journal of Gastrointestinal Surgery / Issue 2/2023
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-022-05541-4

At a glance: The STEP trials

Springer Medicine

Facility Volume Thresholds for Optimization of Short- and Long-Term Outcomes in Patients Undergoing Hepatectomy for Primary Liver Tumors

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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