Impact of surgeon training on outcomes after resective hepatic surgery.
BACKGROUND
Higher hospital and surgeon volumes have been associated with improved outcomes after hepatic resection. Subspecialty training has not previously been associated with improved outcomes after hepatic resection. The objective of this study was to determine what effects, if any, surgeon's volume and training had on the outcomes after hepatic resection.


METHODS
Administrative procedure codes were used to identify all adult patients from the fiscal year 1991-1992 to 2003-2004 who underwent a hepatic resection in two large urban health regions in Canada (Calgary and Capital health regions). The primary outcomes were operative mortality and postoperative complications.


RESULTS
There were 1107 hepatic resections in the stated time period performed by a total of 72 surgeons. There were 66 deaths, resulting in an in-hospital mortality rate of 6.0%, and an overall complication rate of 46%. Statistically significant predictors of operative mortality were: urgency of admission, diagnosis of primary hepatic malignancy, extent of resection, and increasing burden of comorbid medical illness. Surgeon training along with patient's sex, the urgency of admission, diagnosis of primary hepatic malignancy, extent of resection, and increasing comorbidity were predictive of postoperative complications.


CONCLUSIONS
This study found surgeon training to be highly predictive of postoperative complications after hepatic resection.
McKay
Andrew
A
Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
You
Isabelle
I
Bigam
David
D
Lafreniere
Rene
R
Sutherland
Francis
F
Ghali
William
W
Dixon
Elijah
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D013502:General Surgery / Q000193:education* / Q000592:standards; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D015996:Survival Rate