Mortality after liver surgery in Germany

Abstract

Background: Mortality rates after liver surgery are not well documented in Germany. More than 1000 hospitals offer liver resection, but there is no central regulation of infrastructure requirements or outcome quality.Methods: Hospital mortality rates after liver resection were analysed using the standardized hospital discharge data (Diagnosis-Related Groups, ICD-10 and German operations and procedure key codes) provided by the Research Data Centre of the Federal Statistical Office and Statistical Offices of the Länder in Wiesbaden, Germany.Results: A total of 110 332 liver procedures carried out between 2010 and 2015 were identified. The overall hospital mortality rate for all resections was 5⋅8 per cent. The mortality rate among 17 574 major hepatic procedures was 10⋅4 per cent. Patients who had surgery for colorectal liver metastases (CRLMs) had the lowest mortality rate among those with malignancy (5⋅5 per cent), followed by patients with gallbladder cancer (7⋅1 per cent), hepatocellular carcinoma (9⋅3 per cent) and intrahepatic cholangiocarcinoma (11⋅0 per cent). Patients with extrahepatic cholangiocarcinoma had the highest mortality rate (14⋅6 per cent). The mortality rate for extended hepatectomy was 16⋅2 per cent and the need for a biliodigestive anastomosis increased this to 25⋅5 per cent. Failure to rescue after complications led to mortality rates of more than 30 per cent in some subgroups. There was a significant volume-outcome relationship for CRLM surgery in very high-volume centres (mean 26-60 major resections for CRLMs per year). The mortality rate was 4⋅6 per cent in very high-volume centres compared with 7⋅5 per cent in very low-volume hospitals (odds ratio 0⋅60, 95 per cent c.i. 0⋅42 to 0⋅77; P < 0⋅001).Conclusion: This analysis of outcome data after liver resection in Germany suggests that hospital mortality remains high. There should be more focused research to understand, improve or justify factors leading to this result, and consideration of centralization of liver surgery.

Volume–outcome relationship of liver surgery: a nationwide analysis

“…The median hospital volume was low, with two procedures annually, and median surgeon volume was one. In a more recent nationwide analysis, including 110 332 liver resections performed across 1136 German hospitals, the overall mortality rate was 5·8 per cent. There is no centralization in Germany.…”

Author response to: Beyond the scalpel – mortality after liver surgery in patients with liver metastases – time to rethink the indications: Total quality control and just culture for oncologic therapies urgently required!

“…I am happy to respond to the comment by Dr Boda‐Hegemann et al . on our recent publication. We hope that the data lead to a transparent, evidence‐based discussion on the oncological treatment of primary and secondary liver tumours.…”

Beyond the scalpel – mortality after liver surgery in patients with liver metastases – time to rethink the indications

“…We read with interest the recent nationwide analysis of outcomes after liver surgery in Germany. The authors are to be commended for this thorough and honest analysis.…”

“…The authors are to be commended for this thorough and honest analysis. The paper by Filmann et al . was based on hospital discharge data of >100 000 liver procedures between 2010 and 2015, and showed a hospital mortality rate for major hepatic procedures of more than 10 per cent.…”