RT Journal
A1 Dimick JB, Pronovost PJ, Cowan, Jr JA, Lipsett PA
T1 POstoperative complication rates after hepatic resection in maryland hospitals
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD January 1
VO 138
IS 1
SP 41
OP 46
DO 10.1001/archsurg.138.1.41
UL http://dx.doi.org/10.1001/archsurg.138.1.41
AB Hypothesis 
    High-volume centers provide superior quality care and therefore have a lower incidence of postoperative complications.Design 
    Observational statewide administrative database.Setting 
    State of Maryland, nonfederal acute-care hospital (n = 52), performing liver resection (n = 35).Patients 
    All patients discharged after undergoing hepatic resection from 1994 to 1998 (N = 569).Main Outcome Measures 
    Two sequential analyses using multiple logistic regression of in-hospital mortality were performed to determine the relative importance of preoperative case-mix and postoperative complications.Results 
    The overall in-hospital mortality rate was 4.8% and was significantly lower in high-volume hospitals (2.8%) than in low-volume hospitals (10.2%) (P<.001). After adjusting for case-mix in the multivariate analysis, low hospital volume was associated with a 3-fold increase in mortality (odds ratio, 3.1; 95% confidence interval [CI], 1.2-7.6; P = .02). Having surgery at a low-volume hospital was associated with increased rates of several postoperative complications: reintubation (relative risk [RR], 2.5; 95% CI, 1.8-3.4), pulmonary failure (RR, 2.3; 95% CI, 1.6-3.5), pneumonia (RR, 0.35; 95% CI, 1.0-5.6), acute renal failure (RR, 2.0; 95% CI, 1.1-3.7), acute myocardial infarction (RR, 2.6; 95% CI, 1.2-5.9), and aspiration (RR, 1.4; 95% CI, 0.9-2.0). When considering all other factors using statistical methods, hospital volume was no longer associated with mortality.Conclusions 
    Patients who undergo hepatic resection at low-volume hospitals are at a higher risk of postoperative complications and death than those who have the same operation at high-volume hospitals. The empirical difference between outcomes at high- and low-volume hospitals seems to be due to a variation in postoperative complications.