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Journal of Gastrointestinal Surgery

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01-12-2009 | Original Article

Surgeon Volume is Predictive of 5-Year Survival in Patients with Hepatocellular Carcinoma after Resection: A Population-Based Study

Authors: Herng-Ching Lin, Chia-Chin Lin

Published in: Journal of Gastrointestinal Surgery | Issue 12/2009

Abstract

Background and Aim

No study has examined associations between physician volume or hospital volume and survival in patients with liver malignancies in the hepatitis B virus-endemic areas such as Taiwan. This study was to examine the effect of hospital and surgeon volume on 5-year survival and to determine whether hospital or surgeon volume is the stronger predictor in patients with hepatocellular carcinoma after hepatic resection in Taiwan.

Methods

Using the 1997–1999 Taiwan National Health Insurance Research Database and the 1997–2004 Cause of Death Data File, we identified 2,799 patients who underwent hepatic resection and 1,836 deaths during the 5-year follow-up period. The Cox proportional hazard regressions were performed to adjust for patient demographics, comorbidity, physician, and hospital characteristics when assessing the association of hospital and surgeon volume with 5-year survival.

Results

When we examined the effect of physician and hospital volumes separately, both physician and hospital volumes significantly predicted 5-year survival after adjusting for characteristics of patient, surgeon, and hospital. However, after we adjusted for characteristics of physician and hospital, only physician volume remained a significant predictor of the 5-year survival.

Conclusions

Physician volume is a stronger predictor of 5-year survival in hepatocellular carcinoma patients receiving hepatic resection.

Department of Health. Taiwan, ROC. Statistics of causes of death, Vol. I. http://www.doh.gov.tw/EN2006/DM/DM2_p01.aspx?class_no=390&now_fod_list_no=9256&level_no=2&doc_no=51991. Accessed August 12, 2008.

Chen CJ, Yu MW, Liaw YF. Epidemiological characteristics and risk factors of hepatocellular carcinoma. J Gastroenterol Hepatol 1997;12(9–10):S294–S308.CrossRefPubMed

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(4):540–547.PubMed

Fong Y, Blumgart LH, Fortner JG, Brennan MF. Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 1995;222(4):426–437.PubMed

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):309–321.CrossRefPubMed

Luft HS, Garnick DW, Mark DH, McPhee SJ. Hospital Volume, Physician Volume, and Patient Outcomes. Ann Arbor, MI: Health Administrative Press, 1990.

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.CrossRefPubMed

Gandjour A, Bannenberg A, Lauterbach KW. Threshold volumes associated with higher survival in health care: a systematic review. Med Care 2003;41(10):1129–1141.CrossRefPubMed

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.CrossRefPubMed

10.

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.CrossRefPubMed

11.

Blum HE. Treatment of hepatocellular carcinoma. Best Pract Res Clin Gastroenterol 2005;19(1):129–145.CrossRefPubMed

12.

Lee CS, Sheu JC, Wang M, Hsu HC. Long-term outcome after surgery for asymptomatic small hepatocellular carcinoma. Br J Surg 1996;83(3):330–333.CrossRefPubMed

13.

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

14.

Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA. Postoperative complication rates after hepatic resection in Maryland hospitals. Arch Surg 2003;138(1):41–46.PubMedCrossRef

15.

Hannan EL, Kilburn H, Bernard H, O’Donnell JF, Lukacik G, Shields EP. Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors. Med Care 1991;29(11):1094–1107.CrossRefPubMed

16.

Khuri SF, Daley J, Henderson W, Hur K, Hossain M, Soybel D, Kizer KW, Aust JB, Bell RH, Chong V, Demakis J, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, McDonald G, Passaro E, Phillips L, Scamman F, Spencer J, Stremple JF. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann Surg 1999;230(3):414–432.CrossRefPubMed

17.

Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, Legro MW, Diener-West M, Bass EB, Damiano AM, et al. National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures. Ophthalmology 1994;101(6):1131–1141.PubMed

18.

Lavernia CJ. Hemiarthroplasty in hip fracture care: effects of surgical volume on short-term outcome. J Arthroplasty 1998;13(7):774–778.CrossRefPubMed

19.

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

20.

Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995;221(1):43–49.CrossRefPubMed

21.

Wen HC, Tang CH, Lin HC, Tsai CS, Chen CS, Li CY. Association between surgeon and hospital volume in coronary artery bypass graft surgery outcomes: a population-based study. Ann Thorac Surg 2006;81(3):835–842.CrossRefPubMed

22.

Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002;137(6):511–520.PubMed

23.

Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 2003;21(3):401–405.CrossRefPubMed

24.

Hannan EL, O’Donnell JF, Kilburn H, Bernard HR, Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 1989;262(4):503–510.CrossRefPubMed

25.

Luft HS. The relation between surgical volume and mortality: an exploration of causal factors and alternative models. Med Care 1980;18(9):940–959.CrossRefPubMed

26.

Luft HS, Hunt SS, Maerki SC. The volume–outcome relationship: practice-makes-perfect or selective-referral patterns? Health Serv Res 1987;22(2):157–182.PubMed

27.

Flood AB, Scott WR, Ewy W. Does practice make perfect? Part I: the relation between hospital volume and outcomes for selected diagnostic categories. Med Care 1984;22(2):98–114.CrossRefPubMed

28.

Flood AB, Scott WR, Ewy W. Does practice make perfect? Part II: the relation between volume and outcomes and other hospital characteristics. Med Care 1984;22(2):115–125.CrossRefPubMed

Title: Surgeon Volume is Predictive of 5-Year Survival in Patients with Hepatocellular Carcinoma after Resection: A Population-Based Study
Authors: Herng-Ching Lin
Chia-Chin Lin
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0990-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgeon Volume is Predictive of 5-Year Survival in Patients with Hepatocellular Carcinoma after Resection: A Population-Based Study

Abstract

Background and Aim

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and Aim

Methods

Results

Conclusions

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