Higher-volume hospitals linked to reduced mortality, failure to rescue after liver surgery
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Hospitals that performed at least 25 major hepatectomies per year had lower rates of postoperative in-hospital mortality and failure to rescue, suggesting better management of postoperative complications.
“Hospital volume influences postoperative complications after complex digestive surgical procedures. Higher hospital volume is associated with lower mortality rates. This relationship has also been demonstrated for failure to rescue,” Josephine Magnin, of the department of digestive surgical oncology at the University Hospital of Dijon in France, and colleagues wrote in the British Journal of Surgery. “Most studies addressing the impact of hospital volume on postoperative mortality and morbidity after liver surgery have shown discordant results.”
They continued, “The impact of transplant activity in a center on outcomes after liver surgery has been poorly investigated.”
In a nationwide, retrospective study, Magnin and colleagues collected data on 39,286 patients from the French national administrative prospective database for hospital care who underwent liver resection between 2011 and 2019. Studied outcomes included association between hospital volume, in-hospital mortality and failure to rescue (defined as mortality rate among patients with at least one major complication withing 30 days after surgery).
Results demonstrated an in-hospital mortality rate of 2.8% and a failure to rescue rate of 5.5% with an activity volume threshold, in which mortality declined, of 25 hepatectomies (area under the receiver operating curve = 0.833).
High-volume centers (> 25 resections/year) had lower 30-day and 90-day mortality (2.6% vs. 3%) and rates of failure to rescue (5% vs. 6.3%) compared with low-volume centers. However, high-volume centers had higher rates of infection (14.8% vs. 12.7%) and hemodynamic complications (10.4% vs. 9.1%), such as postoperative liver failure (25.6% vs. 20.8%), biliary fistulas (15.3% vs. 10%) and vascular complications (4.7% vs. 3.4%).
The researchers found “no clear benefit” to mortality or failure to rescue associated with the presence of a liver transplant program at the hospital.
“Hospital volume had an impact on postoperative mortality and failure to rescue,” Magnin and colleagues wrote. “Despite more major complications, in-hospital mortality and failure-to-rescue rates were lower in high-volume centers, in particular for minor hepatectomies. This implies that management of complications in high-volume centers is better.
“Specialization of high-volume centers with multi-developed technical equipment and dedicated multidisciplinary teams all contributed to these better results.”
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