title: Improvement of Surgical Records and Outcomes after Hepatectomy at a Single Academic Institute in Japan.
abstract: OBJECTIVE
  To clarify improvement of hepatic resection in the recent years, we examined surgical records of 544 patients who underwent hepatectomy in 3 periods between 1994 and 2011 at a single academic institute.
  
  
  METHODS
  Subjects were divided into 3 groups: group 1 (1994-1999, n = 156), group 2 (2000-2006, n = 228) and group 3 (2007-2011, n = 160). Clinical factors, surgical records and post-hepatectomy outcomes during hospitalization were compared between groups.
  
  
  RESULTS
  In group 3, patient age was significantly higher and the incidences of alcoholic or fatty liver and obstructive jaundice were significantly higher than in group 1 (p < 0.05). Preoperative liver function was not different between groups, and only prothrombin activity was significantly better in group 1 in comparison with the other groups (p < 0.05). In comparison with group 1, the incidence of resident surgeons as the main operator were significantly higher than in group 3 (p < 0.01). Incidences of laparoscopic hepatectomy and thoraco-abdominal approach were increased in group 3 (p < 0.01). Incidences of combined organ and major vessels resections were significantly higher in group 3 in comparison with group 1 (p < 0.01). Use of omental wrapping and hemostatic devices were significantly more frequent in group 3 than in group 1 (p < 0.01). Surgical records were not different between groups but the red cell transfusion rate in group 3 was significantly lower than in group 1 (p < 0.05). Hospital stay in group 3 was significantly shorter than in group 1. Incidence of hepatectomy-related complication, particularly bile leakage, was significantly lower in group 3 than in group 1 (p < 0.05).
  
  
  CONCLUSIONS
  According to this evaluation of different time periods, surgical outcomes have been improved with new surgical procedures and perioperative management.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Goushi
authors.initials: G
authors.lastname: Murakami
authors.forename: Tetsurou
authors.initials: T
authors.lastname: Tominaga
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunizaki
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: To
authors.forename: Takuro
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Tomoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamasaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D007564:Japan; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000592:standards; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult