title: Morbidity and mortality associated with liver resections for primary malignancies in children.
abstract: OBJECTIVE
  Liver resection (LR) is a high-risk procedure with limited data in the pediatric surgical literature regarding short-term outcomes. Our aim was to characterize the patient population and short-term outcomes for children undergoing LR for malignancy.
  
  
  METHODS
  We studied 126 inpatient admissions for children ≤20 years of age undergoing LR in 2009 using the Kids' Inpatient Database. Patients had a principal diagnosis of a primary hepatic malignancy and LR listed as one of the first five procedures. Transplantations were excluded. Complications were defined by ICD-9 codes. High-volume centers performed at least 5 LR.
  
  
  RESULTS
  The mean age was 5.83 years. The morbidity and mortality rates were 30.7 and 3.7%, respectively. The most common causes of morbidity were digestive system complications (7.4%), anemia (7.3%), and respiratory complications (3.8%). 43.9% received a blood product transfusion. The average length of stay was 10.04 days. When compared to low-volume centers, high-volume centers increased the likelihood of a complication fourfold (P = 0.011) but had 0% mortality (P = 0.089).
  
  
  CONCLUSIONS
  LR remains a procedure fraught with multiple complications and a significant mortality rate. High-volume centers have a fourfold increase in likelihood of complications compared to low-volume centers and may be related to extent of hepatic resection.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, WA, 98431, USA, npzwintscher@gmail.com.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Zwintscher
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Azarow
authors.forename: John D
authors.initials: JD
authors.lastname: Horton
mesh_terms: D000704:Analysis of Variance; D000740:Anemia / Q000453:epidemiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004066:Digestive System Diseases / Q000453:epidemiology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D014481:United States / Q000453:epidemiology