title: Trends and Hospital Variations in Surgical Outcomes for Cholangiocarcinoma in New York State.
abstract: This population-based study examined surgical outcomes and hospital and post-acute care resource use after operations of cholangiocarcinoma during 2005-2012.
  
  
  
  Using New York State hospital claims, we identified subjects with intrahepatic tumor who underwent hepatectomy only (n = 2089), subjects with perihilar tumor who underwent hepatectomy and biliary-enteric anastomosis (BEA; n = 389) or BEA only (n = 3721), and subjects with distal cholangiocarcinoma undergoing pancreatectomy or pancreaticoduodenectomy (n = 228). We performed trend analyses for each group and calculated overall risk-adjusted mortality, complication, and 30-day readmission rates for hospitals using multivariable logistic regressions.
  
  
  
  Mortality rate was roughly 12 % over years for perihilar cases undergoing hepatectomy and BEA, significantly higher than the rates of other 3 groups (p = 0.000). The overall complication rate was 40 % for subjects undergoing both hepatectomy and BEA, more than doubling the rate for subjects undergoing hepatectomy or BEA alone (p = 0.000). Average LOS declined markedly for perihilar cases undergoing hepatectomy and BEA (from 21 days in 2005 to 16 days in 2012) and subjects with distal cholangiocarcinoma (from 22 days in 2005 to 16 days in 2012), but other outcomes did not change dramatically. Risk-adjusted hospital outcome rates varied substantially.
  
  
  
  Surgical patients with cholangiocarcinoma incur considerable mortality, postoperative complications, and resource uses, especially among those undergoing hepatectomy and BEA for perihilar tumors.
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
authors: Han
authors: H
authors: Liu
authors: Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642, USA.
authors: Xi
authors: X
authors: Cen
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. simonsuo2016@gmail.com.
authors: Tao
authors: T
authors: Suo
authors: Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Saunders Research Building 4208, 601 Elmwood Ave, Box 630, Rochester, NY, 14642, USA.
authors: Xueya
authors: X
authors: Cai
authors: Sinyoo Information Technology (Shanghai) Co., Ltd., Shanghai, China.
authors: Xuewen
authors: X
authors: Yuan
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
authors: Sheng
authors: S
authors: Shen
authors: Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
authors: Houbao
authors: H
authors: Liu
authors: Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642, USA.
authors: Yue
authors: Y
authors: Li
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009518:New York / Q000453:epidemiology; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010359:Patient Readmission / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology