title: Trends and predictors of outcomes after surgery for hepatocellular carcinoma: A nationwide population-based study in Taiwan.
abstract: BACKGROUND
  Despite the huge and growing global burden of hepatocellular carcinoma (HCC), high-quality population-based studies of HCC prevalence and outcomes are scarce.
  
  
  OBJECTIVE
  To analyze trends and predictors of hospital resource utilization and mortality rates in a population of patients who had received HCC surgery.
  
  
  METHODS
  This population-based patient cohort study retrospectively analyzed 23,107 patients who had received surgical treatment for HCC from 1998 to 2009.
  
  
  RESULTS
  The prevalence rate of surgical treatment in HCC patients significantly increased by 167.4% from 4.857 per 100,000 persons in 1998 to 12.989 per 100,000 persons in 2009 (P < 0.001). Age, gender, Deyo-Charlson co-morbidity index score, hospital volume, surgeon volume, digestive system disease, hepatitis type and liver cirrhosis were significantly associated with HCC surgical outcomes (P < 0.05). Over the 12-year period analyzed, the estimated mean hospital treatment cost increased 9.4% whereas mean length of stay (LOS) decreased 25.3%. The estimated mean overall survival time after HCC surgery was 40.9 months (SD 1.2 months), and the overall in-hospital 1-, 3-, and 5-year survival rates were 97.2%, 79.9%, 61.1%, and 54.6%, respectively.
  
  
  CONCLUSIONS
  These population-based data reveal that the prevalence of HCC has increased, especially in older patients. Additionally, hospital treatment costs for HCC have increased despite decreases in LOS. These analytical results should be applicable to most countries with relatively small populations. Additionally, healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes.
authors.affiliation: Department of General Surgery, Chi Mei Medical Center, Tainan and Liouying, Taiwan; Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Chiu
authors.affiliation: Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology & Hepatology, Chi Mei Medical Center, Tainan and Liouying, Taiwan.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Chi Mei Medical Center, Tainan and Liouying, Taiwan.
authors.forename: T-C
authors.initials: TC
authors.lastname: Tsai
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan and Liouying, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lai
authors.affiliation: Department of General Surgery, Chi Mei Medical Center, Tainan and Liouying, Taiwan.
authors.forename: D-P
authors.initials: DP
authors.lastname: Sun
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: hshi@kmu.edu.tw.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006498:Hepatectomy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D019694:Hepatitis B, Chronic / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000453:epidemiology; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hepatocellular carcinoma; Hospital resource utilization; Mortality rate; Predictors; Trends