Volume–outcome relationship of liver surgery: a nationwide analysis

Abstract

Background: Evidence for an association between hospital volume and outcomes for liver surgery is abundant. The current Dutch guideline requires a minimum volume of 20 annual procedures per centre. The aim of this study was to investigate the association between hospital volume and postoperative outcomes using data from the nationwide Dutch Hepato Biliary Audit.Methods: This was a nationwide study in the Netherlands. All liver resections reported in the Dutch Hepato Biliary Audit between 2014 and 2017 were included. Annual centre volume was calculated and classified in categories of 20 procedures per year. Main outcomes were major morbidity (Clavien-Dindo grade IIIA or higher) and 30-day or in-hospital mortality.Results: A total of 5590 liver resections were done across 34 centres with a median annual centre volume of 35 (i.q.r. 20-69) procedures. Overall major morbidity and mortality rates were 11⋅2 and 2⋅0 per cent respectively. The mortality rate was 1⋅9 per cent after resection for colorectal liver metastases (CRLMs), 1⋅2 per cent for non-CRLMs, 0⋅4 per cent for benign tumours, 4⋅9 per cent for hepatocellular carcinoma and 10⋅3 per cent for biliary tumours. Higher-volume centres performed more major liver resections, and more resections for hepatocellular carcinoma and biliary cancer. There was no association between hospital volume and either major morbidity or mortality in multivariable analysis, after adjustment for known risk factors for adverse events.

Surgical morbidity in the first year after resection for perihilar cholangiocarcinoma

“…30 The association of cholangitis with adverse events after liver surgery and higher risk of major liver resection are common observations in studies on risk factors on postoperative adverse events. 9,13,[31][32][33] The current study confirms these results for adverse events beyond the initial discharge after surgery. Despite the high rates of adverse events, curative intent surgery is associated with the best chance for long-term survival.…”

Short-term postoperative outcomes after liver resection in the elderly patient: a nationwide population-based study

“…2 No ethical approval was needed under Dutch law as the DHBA is part of the Dutch Inspectorate of health care and the dataset is anonymized as described in earlier studies with data from the DHBA. 3,13,14 Patient selection All patients who underwent liver resection for primary and secondary liver tumours between the 1st of January 2014 and the 31st of December 2019 in the Netherlands were included if they were registered in the DHBA before the 22nd of March 2020. Patients were excluded if no date of birth, date of surgery or type of tumour could be obtained.…”

“…16 As a sensitivity analysis, hospital volume was included in multivariable models. 3 Annual overall volume was calculated as total number of liver resections per hospital per year and was categorized <20, 20-39, 40-59, 60-79, and >80 procedures. 3…”

“…2 In the Netherlands, liver resection is most frequently performed for CRLM followed by hepatocellular carcinoma and biliary cancer. 3 Postoperative morbidity and mortality after liver resection for primary and secondary liver tumours tend to increase as older patients are accompanied with more comorbidities and frailty as well as aging of the liver. [4][5][6] During preoperative multidisciplinary treatment meetings, preoperative optimization becomes more important to decrease the negative impact of these comorbidities of patients who face liver resection for primary and secondary liver tumours.…”

Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases: Contemporary Practice, Evidence and Knowledge Gaps

“…The colorectal surgery should be performed by a trained colorectal surgeon and the liver surgery by a trained hepatobiliary surgeon. There is no evidence that higher volume per surgical unit has a relationship with perioperative outcome regarding the liver resection part of the procedure [ 35 ], so specific volume requirements should not be necessary. In colorectal cancer surgery, however, high volume by surgeon and high volume by hospital have been associated with better outcomes, although the optimal threshold for a minimum number of procedures is yet to be identified [ 36 ].…”