title: [Quality standards in liver surgery: influence of multidisciplinary team work and patient centralization].
abstract: BACKGROUND
  Multidisciplinary team work and centralization of health care in specialized teams, improves outcomes and quality of assistance in medical practice.
  
  
  OBJECTIVE
  To describe the evolution of surgical and anesthetic practice and outcomes during a period of improving team work and centralization of liver surgery.
  
  
  METHODS
  A retrospective descriptive study of the type of surgery, anesthesia practice, outcomes and hospitalization was performed in 68 patients that underwent major hepatic surgery in our service, between Febriary 2004 and December 2007.
  
  
  RESULTS
  Fifty-one patients (75%) had hydatid liver disease. Ten surgeries (15%) were categorized as major; 20 (29%) as minor and 38 (56%) as hydatidic cystectomy. The number of surgeries tends to increase by year: 2004 (n = 13); 2005 (n = 14); 2006 (n = 18); 2007 (n = 23). An 87% of the anesthetics techniques were combined: epidural-general (n = 49; 72%) and spinal-general (n = 10O; 15%). The use of thoracic epidural was 0% in 2004 and 59% in 2007. A 62% of the cases bled less than 500 mL and 28% of the patients were transfused. The transfused volume in those patients (1,120 +/- 618mL) was 12% of the mean volume documented in 1998 in the same surgical service. There were no re-interventions or mortality. An 85% of the patients were admitted to the intensive care unit (ICU) for postoperative care in 2004 compared with only 22% in 2007. An 80% of the patients were discharged fom the hospital in the first 8 days after surgery (the majority by the fourth day).
  
  
  CONCLUSIONS
  Our multidisciplinary approach and teamwork may have positively influenced quality standards in liver surgery by diminishing transfusions of blood products and utilization of ICU resources.
authors.affiliation: Servicio de Enfermedades Hepáticas y Transplante, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. karina.rando@gmail.com
authors.forename: Karina
authors.initials: K
authors.lastname: Rando
authors.forename: Martín
authors.initials: M
authors.lastname: Harguindeguy
authors.forename: Alejandro
authors.initials: A
authors.lastname: Leites
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ettlin
authors.forename: Sara
authors.initials: S
authors.lastname: González
authors.forename: Paola
authors.initials: P
authors.lastname: Scalone
authors.forename: Paula
authors.initials: P
authors.lastname: Martínez
authors.forename: María
authors.initials: M
authors.lastname: Viñoly
authors.forename: Solange
authors.initials: S
authors.lastname: Gerona
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D002497:Centralized Hospital Services; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D012189:Retrospective Studies