Surgeon volume is predictive of 5-year survival in patients with hepatocellular carcinoma after resection: a population-based study .
OBJECTIVE
No study has examined associations between physician volume or hospital volume and survival in patients with liver malignancies in the hepatitis B virus-endemic areas such as Taiwan. This study was to examine the effect of hospital and surgeon volume on 5-year survival and to determine whether hospital or surgeon volume is the stronger predictor in patients with hepatocellular carcinoma after hepatic resection in Taiwan.


METHODS
Using the 1997-1999 Taiwan National Health Insurance Research Database and the 1997-2004 Cause of Death Data File, we identified 2,799 patients who underwent hepatic resection and 1,836 deaths during the 5-year follow-up period. The Cox proportional hazard regressions were performed to adjust for patient demographics, comorbidity, physician, and hospital characteristics when assessing the association of hospital and surgeon volume with 5-year survival.


RESULTS
When we examined the effect of physician and hospital volumes separately, both physician and hospital volumes significantly predicted 5-year survival after adjusting for characteristics of patient, surgeon, and hospital. However, after we adjusted for characteristics of physician and hospital, only physician volume remained a significant predictor of the 5-year survival.


CONCLUSIONS
Physician volume is a stronger predictor of 5-year survival in hepatocellular carcinoma patients receiving hepatic resection.
Lin
Herng-Ching
HC
School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
Lin
Chia-Chin
CC
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery; D005260:Female; D013502:General Surgery; D006761:Hospitals / Q000600:supply & distribution*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D000078329:Workforce