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High Volume and Outcome After Liver Resection: Surgeon or Center?

High Volume and Outcome After Liver Resection: Surgeon or Center?,10.1007/s11605-008-0627-3,Journal of Gastrointestinal Surgery,Robert W. Eppsteiner,N

High Volume and Outcome After Liver Resection: Surgeon or Center?   (Citations: 13)
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Introduction  In a case controlled analysis, we attempted to determine if the volume–survival benefit persists in liver resection (LR) after eliminating differences in background characteristics. Methods  Using the Nationwide Inpatient Sample (NIS), we identified all LR (n = 2,949) with available surgeon/hospital identifiers performed from 1998–2005. Propensity scoring adjusted for background characteristics. Volume cut-points were selected to create equal groups. A logistic regression for mortality was then performed with these matched groups. Results  At high volume (HV) hospitals, patients (n = 1423) were more often older, white, private insurance holders, elective admissions, carriers of a malignant diagnosis, and high income residents (p < 0.05). Propensity matching eliminated differences in background characteristics. Adjusted in-hospital mortality was significantly lower in the HV group (2.6% vs. 4.8%, p = 0.02). Logistic regression found that private insurance and elective admission type decreased mortality; preoperative comorbidity increased mortality. Only LR performed by HV surgeons at HV centers was independently associated with improved in-hospital mortality (HR, 0.43; 95% CI, 0.22–0.83). Conclusions  A socioeconomic bias may exist at HV centers. When these factors are accounted for and adjusted, center volume does not appear to influence in-hospital mortality unless LR is performed by HV surgeons at HV centers.
Journal: Journal of Gastrointestinal Surgery - J GASTROINTEST SURG , vol. 12, no. 10, pp. 1709-1716, 2008
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    • ...We used the Nationwide Inpatient Sample (NIS) for the years 1998 to 2006 to extract data for all patients with a primary ICD-9-CM procedure code for any type of colon resection (Table 1). Our methods have been described previously [13, 16]...

    Anand Singlaet al. Hospital volume as a surrogate for laparoscopically assisted colectomy

    • ...Propensity scores were used to further investigate whether differences in outcomes by selected surgeon volume groups were dependent on disparities in patient population and disease characteristics as previously described [9, 15]...
    • ...Due to the rise in cholecystectomy overall for a variety of procedures including biliary colic, we felt it was important for the cohort to be focused using patients that needed surgical intervention and required expertise such as AC. As we have previously described, using the surgeon identifier in the NIS enables us to study over 80,000 cases across 12 states in the 8-year period [15]...
    • ...The role and importance of surgeon and center remain intertwined and difficult to delineate in most complex medical disorders and surgical procedures [15]...

    Nicholas G. Csikeszet al. Surgeon Volume Metrics in Laparoscopic Cholecystectomy

    • ...Our methods are as previously described [3, 4]. The NIS is the largest national allpayer hospital inpatient care database in the United States...

    Beth Colomboet al. Current Trends and Short-term Outcomes of Live Donor Nephrectomy: A Po...

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