The combined effects of hospital and surgeon volume on short-term survival after hepatic resection in a population-based study.
BACKGROUND
The influence of different hospital and surgeon volumes on short-term survival after hepatic resection is not clearly clarified. By taking the known prognostic factors into account, the purpose of this study is to assess the combined effects of hospital and surgeon volume on short-term survival after hepatic resection.


METHODS
13,159 patients who underwent hepatic resection between 2002 and 2006 were identified in the Taiwan National Health Insurance Research Database. Data were extracted from it and short-term survivals were confirmed through 2006. The Cox proportional hazards model was used to assess the relationship between survival and different hospital, surgeon volume and caseload combinations.


RESULTS
High-volume surgeons in high-volume hospitals had the highest short-term survivals, following by high-volume surgeons in low-volume hospitals, low-volume surgeons in high-volume hospitals and low-volume surgeons in low-volume hospitals. Based on Cox proportional hazard models, although high-volume hospitals and surgeons both showed significant lower risks of short-term mortality at hospital and surgeon level analysis, after combining hospital and surgeon volume into account, high-volume surgeons in high-volume hospitals had significantly better outcomes; the hazard ratio of other three caseload combinations ranging from 1.66 to 2.08 (p<0.001) in 3-month mortality, and 1.28 to 1.58 (p<0.01) in 1-year mortality.


CONCLUSIONS
The combined effects of hospital and surgeon volume influenced the short-term survival after hepatic resection largely. After adjusting for the prognostic factors in the case mix, high-volume surgeons in high-volume hospitals had better short-term survivals. Centralization of hepatic resection to few surgeons and hospitals might improve patients' prognosis.
Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan ; School of Medicine, Tzu Chi University, Hualian, Taiwan.
Chun-Ming
CM
Chang
Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan ; School of Medicine, Tzu Chi University, Hualian, Taiwan.
Wen-Yao
WY
Yin
Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan ; School of Medicine, Tzu Chi University, Hualian, Taiwan.
Chang-Kao
CK
Wei
Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan ; School of Medicine, Tzu Chi University, Hualian, Taiwan.
Cheng-Hung
CH
Lee
Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan ; Center for Clinical Epidemiology and Biostatistics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan ; School of Medicine, Tzu Chi University, Hualian, Taiwan.
Ching-Chih
CC
Lee
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D016016:Proportional Hazards Models; D012307:Risk Factors; D013043:Specialties, Surgical; D015996:Survival Rate; D013624:Taiwan