Recent trends of hepatic resection in Canada: 1995-2004.
BACKGROUND
Recently, many surgical procedures have become regionalized in the United States, likely owing to research demonstrating a relationship between volume and outcome. We sought to describe patient characteristics and outcomes according to hospital volume along with patterns of regionalization for hepatic resection in Canada from 1995 to 2004.


METHODS
Discharge data from all hospitals across Canada except Quebec were obtained from the Canadian Institute for Health Information for 1995-2004. All patients undergoing a hepatic resection were identified using ICD-9 and ICD-10 codes. High-volume hospitals were defined as those performing ten or more procedures per year.


RESULTS
A total of 9,912 patients (mean age 59 years) underwent hepatic resection. The proportion of procedures performed at high-volume hospitals increased from 42% in 1995 to 84% in 2004. Overall mortality rate for the study period was 5.0% which decreased over time. Mortality rates were higher at low-volume (6.1%) compared to high-volume centers (4.6%), but this finding was not statistically significant (p = 0.7451). Those factors predictive of mortality in a multivariate analysis included age, gender, year of operation, operative indication, comorbidity score, and admission status.


CONCLUSIONS
Mortality rates have significantly improved. Hospital volume is not a significant predictor of mortality following liver resection in Canada.
McColl
Ryan J
RJ
Department of Surgery, University of Calgary, Calgary, AB, Canada.
You
Xiaoqing
X
Ghali
William A
WA
Kaplan
Gilaad
G
Myers
Robert
R
Dixon
Elijah
E
D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002170:Canada; D016009:Chi-Square Distribution; D005260:Female; D019538:Health Care Surveys; D006498:Hepatectomy / Q000401:mortality* / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States
Ann Surg. 1999 Mar;229(3):322-30
10077043
Arch Surg. 1999 Jan;134(1):30-5
9927127
Ann Surg. 1992 Oct;216(4):493-504; discussion 504-5
1417198
JAMA. 2000 Mar 1;283(9):1159-66
10703778
J Gastrointest Surg. 2005 Jan;9(1):109-14
15623451
World J Surg. 2005 Oct;29(10):1230-3
16132398
Ann Surg. 1987 Mar;205(3):256-63
3827361
JAMA. 1998 Nov 25;280(20):1747-51
9842949
Ann Surg. 2002 Oct;236(4):397-406; discussion 406-7
12368667
World J Surg. 1995 Jan-Feb;19(1):59-71
7740812
J Am Coll Surg. 2000 Jul;191(1):38-46
10898182
N Engl J Med. 1979 Dec 20;301(25):1364-9
503167
CMAJ. 2003 May 27;168(11):1409-14
12771069
Ann Surg. 1999 Sep;230(3):309-18; discussion 318-21
10493478
Br J Surg. 2001 Jun;88(6):808-13
11412249
Eff Clin Pract. 2000 Nov-Dec;3(6):313-6
11151534
J Chronic Dis. 1987;40(5):373-83
3558716
Arch Surg. 2003 Feb;138(2):185-91
12578418
Cancer. 1996 Apr 1;77(7):1254-62
8608500
J Am Coll Surg. 2007 Nov;205(5):676-83
17964443
J Am Coll Surg. 1999 Jul;189(1):46-56
10401740
J Clin Oncol. 1997 Mar;15(3):938-46
9060531
Eff Clin Pract. 1999 Nov-Dec;2(6):277-83
10788026
Ann Surg. 2002 Apr;235(4):579-85
11923615
Ann Surg Oncol. 2006 Jan;13(1):58-65
16372158
Am J Public Health. 2003 Jan;93(1):52-6
12511384
CMAJ. 1999 Mar 9;160(5):643-8
10101998
Ann Surg Oncol. 2001 May;8(4):347-53
11352309
Surgery. 1994 Oct;116(4):703-10; discussion 710-1
7940169
Can J Surg. 2006 Aug;49(4):251-8
16948883
Surgery. 2001 Sep;130(3):415-22
11562662
J Am Coll Surg. 2004 Jul;199(1):31-8
15217626
J Am Coll Surg. 2000 Mar;190(3):341-9
10703862
J Gastrointest Surg. 1998 Jan-Feb;2(1):11-20
9841963
N Engl J Med. 2002 Apr 11;346(15):1128-37
11948273
Ann Surg. 2001 Oct;234(4):507-17; discussion 517-9
11573044