The Effect of Surgical Volume and the Provision of Residency and Fellowship Training on Complications of Major Hepatic Resection

Kohn, Geoffrey P.; Nikfarjam, Mehrdad

doi:10.1007/s11605-010-1310-z

Cited by 31 publications

(23 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Interestingly, this positive volumeoutcomes relationship may plateau at a certain point and then diminish. In a study of hepatic resection, greater volume was associated with improvements in mortality up to an annual caseload of 50; the mortality rate then increased when greater than approximately 70 cases were performed per annum [8]. This may reflect the high degree of complexity seen at the largest referral centers.…”

Section: Introductionmentioning

confidence: 99%

NSQIP Reveals Significant Incidence of Death Following Discharge

Yu¹,

Chang²,

Osen³

et al. 2011

Journal of Surgical Research

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

NSQIP Reveals Significant Incidence of Death Following Discharge

Yu¹,

Chang²,

Osen³

et al. 2011

Journal of Surgical Research

View full text Add to dashboard Cite

“…[20][21][22] These have broadly supported the hypothesis that patients treated at the latter centres experience more favourable outcomes. As the proportion of physicians with fellowship training at academic institutions is putatively higher at NCI-designated CC, this may facilitate the achievement of superior perioperative outcomes at these centres.…”

Section: Discussionmentioning

confidence: 58%

Perioperative outcomes after radical cystectomy at NCI-designated centres: Are they any better?

Roghmann

Ravi

Hanske

et al. 2015

CUAJ

View full text Add to dashboard Cite

Introduction: In 1971, the National Cancer Institute (NCI) introduced a network of NCI-designated Cancer Centers (CC), which underwent a comprehensive approval process relying on research, education and prevention activities. In this study, we examine the effect of CC status on perioperative outcomes after radical cystectomy (RC). Methods: Within the Nationwide Inpatient Sample, we focused on RC performed from 2006 to 2010. As all recognized centres were residency teaching institutions, we stratified according to teaching and CC-teaching status. We examined the rates of in-hospital mortality, intra-and postoperative complications, prolonged length of hospital stay, as well as blood transfusion. Multivariable logistic regression analyses were further adjusted for confounding factors. Results: Overall, 22 840 RC patients (5451 at non-teaching, 10 857 at residency teaching, 6532 at CC-teaching institutions) were identified. Patients treated at residency teaching and CC-teaching institutions were younger, had less comorbidities, and more likely to have private insurance. In multivariable analyses, patients treated at residency and CC-teaching institutions were less likely to experience postoperative complications (odds ratio [OR] 0.73 and 0.66, respectively) and blood transfusions (OR 0.77 and 0.53, respectively) relative to patients treated at non-teaching institutions. In addition, CC patients were also less likely to experience in-hospital mortality (OR 0.61, all p < 0.001) as compared to non-teaching institutions. Conclusions: On average, patients treated at residency and CC-teaching institutions are less likely to experience unfavourable outcomes after RC. Moreover, patients treated at CC fared better than patients treated at residency teaching institutions. Our findings acknowledge the quality of RC care at accredited centres.

show abstract

“…There are at least 2 expla nations for this unexpected negative effect. First, this effect may resemble the U-shaped mortality curve, as shown with esophageal surgery or major liver resections, 19,20 which is commonly related to the phenomenon of "overconfidence." This phenomenon has been reported previously, although to a lesser extent, in a renal transplant setting.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Grąt

Lewandowski²,

Patkowski³

et al. 2018

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: Data on the relevance of surgeon experience in liver transplant procedures are scarce. In this study, we evaluated the effects of individual surgeon experience on survival outcomes after deceased-donor liver transplant. Materials and Methods:In this retrospective analysis of 1193 liver transplant procedures, quantile regression for survival data was performed to assess the effects of surgeon experience. Conditional quantiles of mortality and graft loss were set as primary and secondary outcome measures, respectively, which were categorized as early, midterm, and late. Results: Greater experience of a surgeon performing hepatectomy increased the risk of early mortality (P = .005) and graft loss (P = .025) when the recipient Model for End-Stage Liver Disease was ≤ 25 and the donor Model for End-Stage Liver Disease was ≤ 1600. In conventional transplant procedures, greater experience of surgeon performing hepatectomy additionally increased the risk of midterm mortality (P = .027) and graft loss (P = .046). Conversely, a graft implant procedure performed by a more experienced surgeon was associated with better early, midterm, and late outcomes after conventional transplants (all P < .037) and reduced the risk of early graft loss when the donor Model for End-Stage Liver Disease score was > 1600 (P = .027). Conclusions: Unexpectedly, individual surgeon experience yields bimodal effects on posttransplant outcomes, dependent on the stage of operation, operative technique, severity of recipient status, and transplant risk profile. Key words: Center volume, Donor model for end-stage liver disease score, Mortality, Risk profile IntroductionLiver transplant is one of the most complex surgical procedures, with postoperative mortality rates ranging from 3% to 12% and 5-year survival rates ranging from 70% to 75%. [1][2][3][4][5] Numerous studies available in the transplant literature have reported risk factors for poor outcomes. Those of most relevance have reported outcomes attributable to recipients, donors, and operative procedural characteristics. 1,4,6,7 In addition, the role of combined factors, such as the donor Model for End-Stage Liver Disease (D-MELD) score introduced by Halldorson and associates and derived from recipient MELD score and donor age, has been recently advocated. 8,9 However, data on the association between the individual experience of the surgeon and patient outcomes after deceased-donor liver transplant are scarce. Notably, surgeon experience has been previously reported as a factor significantly related to postoperative outcomes in other transplant procedures and in procedures in the field of general surgery. [10][11][12][13] Given the worldwide shortage of donors, the optimal utilization of the scarce resources is of basic importance. Previously, much attention has been given to the association between case volume at a particular transplant center and posttransplant outcomes. Several groups who studied related topics have found that outcomes of liver transplants performed at hig...

show abstract

The Effect of Surgical Volume and the Provision of Residency and Fellowship Training on Complications of Major Hepatic Resection

Abstract: Greater annual major hepatectomy volume improves outcomes with reduced mortality up to a certain point. The presence of surgical residency program but not a fellowship program is associated with reduced predicted morbidity and mortality.

Cited by 31 publications

References 22 publications

NSQIP Reveals Significant Incidence of Death Following Discharge

NSQIP Reveals Significant Incidence of Death Following Discharge

Perioperative outcomes after radical cystectomy at NCI-designated centres: Are they any better?

Untitled

Contact Info

Product

Resources

About