Top

Journal of Gastrointestinal Surgery

Published in:

01-11-2008 | 2008 plenary presentation

Recent Trends of Hepatic Resection in Canada: 1995–2004

Authors: Ryan J. McColl, Xiaoqing You, William A. Ghali, Gilaad Kaplan, Robert Myers, Elijah Dixon

Published in: Journal of Gastrointestinal Surgery | Issue 11/2008

Abstract

Introduction

Recently, many surgical procedures have become regionalized in the United States, likely owing to research demonstrating a relationship between volume and outcome. We sought to describe patient characteristics and outcomes according to hospital volume along with patterns of regionalization for hepatic resection in Canada from 1995 to 2004.

Methods

Discharge data from all hospitals across Canada except Quebec were obtained from the Canadian Institute for Health Information for 1995–2004. All patients undergoing a hepatic resection were identified using ICD-9 and ICD-10 codes. High-volume hospitals were defined as those performing ten or more procedures per year.

Results

A total of 9,912 patients (mean age 59 years) underwent hepatic resection. The proportion of procedures performed at high-volume hospitals increased from 42% in 1995 to 84% in 2004. Overall mortality rate for the study period was 5.0% which decreased over time. Mortality rates were higher at low-volume (6.1%) compared to high-volume centers (4.6%), but this finding was not statistically significant (p = 0.7451). Those factors predictive of mortality in a multivariate analysis included age, gender, year of operation, operative indication, comorbidity score, and admission status.

Discussion

Mortality rates have significantly improved. Hospital volume is not a significant predictor of mortality following liver resection in Canada.

Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 1999;229(3):322–330. doi:10.1097/00000658-199903000-00004.PubMedCrossRef

Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230(3):309–318. (discussion 318–321). doi:10.1097/00000658-199909000-00004.PubMedCrossRef

Gayowski TJ, Iwatsuki S, Madariaga JR, Selby R, Todo S, Irish W, Starzl T. Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors. Surgery 1994;116(4):703–710. (discussion 710–701).PubMed

Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996;77(7):1254–1262. doi:10.1002/(SICI)1097-0142(19960401)77:7<1254::AID-CNCR5>3.0.CO;2-I.PubMedCrossRef

Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg 1995;19(1):59–71. doi:10.1007/BF00316981.PubMedCrossRef

Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, Youssef BAM, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 2001;234(4):507–517. (discussion 517–509). doi:10.1097/00000658-200110000-00010.PubMedCrossRef

Charny CK, Jarnagin WR, Schwartz LH, Frommeyer HS, DeMatteo RP, Fong Y, Blumgart LH. Management of 155 patients with benign liver tumours. Br J Surg 2001;88(6):808–813. doi:10.1046/j.0007-1323.2001.01771.x.PubMedCrossRef

Dimick JB, Cowan JA Jr, Knol JA, Upchurch GR Jr. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg 2003;138(2):185–191. doi:10.1001/archsurg.138.2.185.PubMedCrossRef

Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzmann JV, Cameron JL, Gordon TA. Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg 1998;2(1):11–20. doi:10.1016/S1091-255X(98)80098-X.PubMedCrossRef

10.

Dimick JB, Wainess RM, Cowan JA, Upchurch GR Jr, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg 2004;199(1):31–38. doi:10.1016/j.jamcollsurg.2004.03.005.PubMedCrossRef

11.

Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280(20):1747–1751. doi:10.1001/jama.280.20.1747.PubMedCrossRef

12.

Glasgow RE, Showstack JA, Katz PP, Corvera CU, Warren RS, Mulvihill SJ. The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Arch Surg 1999;134(1):30–35. doi:10.1001/archsurg.134.1.30.PubMedCrossRef

13.

Gordon TA, Bowman HM, Bass EB, Lillemoe KD, Yeo CJ, Heitmiller RF, Choti MA, Burleyson GP, Hsieh G, Cameron JL. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg 1999;189(1):46–56. doi:10.1016/S1072-7515(99)00072-1.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(5):676–683. doi:10.1016/j.jamcollsurg.2007.06.283.PubMedCrossRef

15.

Simunovic M, Rempel E, Theriault ME, Coates A, Whelan T, Holowaty E, Langer B, Levine M. Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. Can J Surg 2006;49(4):251–258.PubMed

16.

Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000;283(9):1159–1166. doi:10.1001/jama.283.9.1159.PubMedCrossRef

17.

Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery 2001;130(3):415–422. doi:10.1067/msy.2001.117139.PubMedCrossRef

18.

Birkmeyer JD. Should we regionalize major surgery? Potential benefits and policy considerations. J Am Coll Surg 2000;190(3):341–349. doi:10.1016/S1072-7515(99)00270-7.PubMedCrossRef

19.

Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346(15):1128–1137. doi:10.1056/NEJMsa012337.PubMedCrossRef

20.

Dimick JB, Stanley JC, Axelrod DA, Kazmers A, Henke PK, Jacobs LA, Wakefield TW, Greenfield LJ, Upchurch GR Jr. Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age. Ann Surg 2002;235(4):579–585. doi:10.1097/00000658-200204000-00017.PubMedCrossRef

21.

Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301(25):1364–1369.PubMed

22.

Milstein A, Galvin RS, Delbanco SF, Salber P, Buck CR Jr. Improving the safety of health care: the leapfrog initiative. Eff Clin Pract 2000;3(6):313–316.PubMed

23.

Birkmeyer JD, Lucas FL, Wennberg DE. Potential benefits of regionalizing major surgery in Medicare patients. Eff Clin Pract 1999;2(6):277–283.PubMed

24.

Urbach DR, Bell CM, Austin PC. Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization. CMAJ 2003;168(11):1409–1414.PubMed

25.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–383. doi:10.1016/0021-9681(87)90171-8.PubMedCrossRef

26.

Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236(4):397–406. (discussion 406–397). doi:10.1097/00000658-200210000-00001.PubMedCrossRef

27.

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000;191(1):38–46. doi:10.1016/S1072-7515(00)00261-1.PubMedCrossRef

28.

Masi G, Cupini S, Marcucci L, Cerri E, Loupakis F, Allegrini G, Brunetti IM, Pfanner E, Viti M, Goletti O, Filipponi F, Falcone A. Treatment with 5-fluorouracil/folinic acid, oxaliplatin, and irinotecan enables surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer. Ann Surg Oncol 2006;13(1):58–65. doi:10.1245/ASO.2006.03.094.PubMedCrossRef

29.

Adam R, Avisar E, Ariche A, Giachetti S, Azoulay D, Castaing D, Kunstlinger F, Levi F, Bismuth F. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol 2001;8(4):347–353. doi:10.1007/s10434-001-0347-3.PubMedCrossRef

30.

Rosen CB, Nagorney DM, Taswell HF, Helgeson SL, Ilstrup DM, van Heerden JA, Adson MA. Perioperative blood transfusion and determinants of survival after liver resection for metastatic colorectal carcinoma. Ann Surg 1992;216(4):493–504. (discussion 504–495). doi:10.1097/00000658-199210000-00012.PubMedCrossRef

31.

Nordlinger B, Quilichini MA, Parc R, Hannoun L, Delva E, Huguet C. Hepatic resection for colorectal liver metastases. Influence on survival of preoperative factors and surgery for recurrences in 80 patients. Ann Surg 1987;205(3):256–263. doi:10.1097/00000658-198703000-00007.PubMedCrossRef

32.

Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997;15(3):938–946.PubMed

33.

Urbach DR, Croxford R, MacCallum NL, Stukel TA. How are volume-outcome associations related to models of health care funding and delivery? A comparison of the United States and Canada. World J Surg 2005;29(10):1230–1233. doi:10.1007/s00268-005-7994-7.PubMedCrossRef

34.

Brown LD. Comparing health systems in four countries: lessons for the United States. Am J Public Health 2003;93(1):52–56.PubMedCrossRef

35.

Simunovic M, To T, Theriault M, Langer B. Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system. CMAJ 1999;160(5):643–648.PubMed

36.

Dixon E, Vollmer CM Jr, Bathe O, Sutherland F. Training, practice, and referral patterns in hepatobiliary and pancreatic surgery: survey of general surgeons. J Gastrointest Surg 2005;9(1):109–114. doi:10.1016/j.gassur.2004.03.008.PubMedCrossRef

Title: Recent Trends of Hepatic Resection in Canada: 1995–2004
Authors: Ryan J. McColl
Xiaoqing You
William A. Ghali
Gilaad Kaplan
Robert Myers
Elijah Dixon
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 11/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0679-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Recent Trends of Hepatic Resection in Canada: 1995–2004

Abstract

Introduction

Methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Discussion

Please log in to get access to this content

Other articles of this Issue 11/2008

Can Gastric Irrigation Prevent Infection During NOTES Mesh Placement?

Monopolar Floating Ball Versus Bipolar Forceps for Hepatic Resection: A Prospective Randomized Clinical Trial

Hepatic Neuroendocrine Metastases: Chemo- or Bland Embolization?

Management of Preoperatively Suspected Choledocholithiasis: A Decision Analysis

Inpatient Mortality Analysis of Paraesophageal Hernia Repair in Octogenarians

ERCC1 RNA Expression in Peripheral Blood Predicts Minor Histopathological Response to Neoadjuvant Radio-chemotherapy in Patients with Locally Advanced Cancer of the Esophagus