title: Volume-outcome associations after major hepatectomy for hepatocellular carcinoma: a nationwide Taiwan study.
abstract: OBJECTIVE
  The objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test.
  
  
  RESULTS
  The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001).
  
  
  CONCLUSIONS
  The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.
authors.affiliation: Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lu
authors.forename: Chong-Chi
authors.initials: CC
authors.lastname: Chiu
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Chiu
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006498:Hepatectomy / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D017721:Hospital Costs; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan; D016896:Treatment Outcome
references.citation: Ann Surg. 2012 Nov;256(5):697-704; discussion 704-5
references.pmid: 23095612
references.citation: Health Policy. 2010 Jan;94(1):61-7
references.pmid: 19762105
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: Liver Int. 2013 Sep;33(8):1281-6
references.pmid: 23710596
references.citation: Am J Epidemiol. 1999 Aug 15;150(4):327-33
references.pmid: 10453808
references.citation: Ann Surg. 2012 May;255(5):940-5
references.pmid: 22504193
references.citation: Kaohsiung J Med Sci. 2003 May;19(5):225-32
references.pmid: 12822679
references.citation: J Gastrointest Surg. 2013 Dec;17(12):2114-22
references.pmid: 24072683
references.citation: Gastroenterology. 2005 Aug;129(2):486-93
references.pmid: 16083705
references.citation: J Am Coll Surg. 2009 Apr;208(4):528-38
references.pmid: 19476786
references.citation: Br J Surg. 2007 Feb;94(2):145-61
references.pmid: 17256810
references.citation: Patient Prefer Adherence. 2013 Jul 11;7:693-701
references.pmid: 23874090
references.citation: JAMA. 1997 Aug 13;278(6):485-90
references.pmid: 9256223
references.citation: JAMA. 2010 Jul 7;304(1):95-7
references.pmid: 20606158
references.citation: HPB (Oxford). 2005;7(3):226-30
references.pmid: 18333195
references.citation: Ann Surg Oncol. 2008 May;15(5):1348-55
references.pmid: 18306973
references.citation: J Gastrointest Surg. 2013 Jan;17(1):21-8; discussion p.28-9
references.pmid: 22965650
references.citation: Dig Surg. 2012;29(5):374-83
references.pmid: 23128369
references.citation: Chang Gung Med J. 2003 Apr;26(4):259-68
references.pmid: 12846525
references.citation: J Aging Soc Policy. 2001;13(2-3):203-16
references.pmid: 12216356
references.citation: Qual Saf Health Care. 2004 Apr;13(2):98-101
references.pmid: 15069215
references.citation: Psychiatr Serv. 1996 Jun;47(6):608-13
references.pmid: 8726487
references.citation: J Nurs Adm. 1993 Apr;23(4):14-8
references.pmid: 8473939
references.citation: Surg Endosc. 2012 Jun;26(6):1602-8
references.pmid: 22179464
references.citation: Acta Neurol Taiwan. 2008 Mar;17(1):17-25
references.pmid: 18564823
references.citation: Hepatogastroenterology. 2003 May-Jun;50(51):798-804
references.pmid: 12828088
references.citation: PLoS One. 2012;7(4):e35781
references.pmid: 22563399
references.citation: Am Surg. 2012 Apr;78(4):456-67
references.pmid: 22472405
references.citation: JAMA. 1988 Feb 5;259(5):696-700
references.pmid: 3336188
references.citation: J Clin Oncol. 2013 Feb 10;31(5):551-7
references.pmid: 23295792
references.citation: Eur J Surg Oncol. 2013 Nov;39(11):1230-5
references.pmid: 23994139
references.citation: Surg Oncol. 2012 Sep;21(3):e131-41
references.pmid: 22658833
references.citation: Ann Surg. 2009 Jul;250(1):159-65
references.pmid: 19561457
references.citation: J Gastrointest Surg. 2012 Nov;16(11):2126-31
references.pmid: 22878787
references.citation: J Gastrointest Surg. 2013 Nov;17(11):1984-96
references.pmid: 24002759
references.citation: Health Policy. 2007 Jun;82(1):28-36
references.pmid: 16989921