Stevens Claire L, Babidge Wendy J, Maddern Guy J
Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
Australia and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
ANZ J Surg. 2018 Oct;88(10):1022-1027. doi: 10.1111/ans.14408. Epub 2018 Feb 8.
Hepatic resection is a relatively young and complex specialized procedure. A strong relationship between volume and perioperative mortality has been reported internationally. However, there has been no multicentre study into hepatic resection in Australia. This retrospective, population-based cohort study was conducted to determine national, state and territory based volume and perioperative mortality rates (POMRs).
Australian Institute of Health and Welfare data was interrogated for the Australian Classification of Health Intervention codes for hepatic resection defined as extended hemi-hepatectomy (30421), hemi-hepatectomy (30418), segmental hepatic resection (30415) and sub-segmental hepatic resection (30414). Logistic regression analysis was performed using the de-identified data to investigate trends and differences between states/territories. Mortality rates were risk adjusted for age, gender and public or private admission. The data set included patients who underwent hepatic resection in the financial years 2005/2006 to 2012/2013.
The overall POMR for all types of hepatic resection was 1.6% (201/12 562). There was no significant change in POMR over time. However, there was significant variation between the states and territories with two states having significantly higher POMR for major hepatic resections (regional range: 1.3-3.8%). POMRs increased with age with the highest mortality seen in the 75-79 year age group. The POMR was lower in private than in public hospitals.
The results of this study confirm that the overall Australian POMR for major hepatic resection is similar to results reported internationally. National and state/territory POMR has not varied significantly over time. The significant variation between states/territories warrants further investigation.
肝切除术是一项相对新兴且复杂的专业手术。国际上已报道手术量与围手术期死亡率之间存在密切关系。然而，澳大利亚尚未开展关于肝切除术的多中心研究。本项基于人群的回顾性队列研究旨在确定全国、各州及领地的手术量及围手术期死亡率（POMR）。
查询澳大利亚卫生与福利研究所的数据，获取澳大利亚健康干预分类代码中定义为扩大半肝切除术（30421）、半肝切除术（30418）、肝段切除术（30415）和肝亚段切除术（30414）的肝切除术数据。使用去识别化数据进行逻辑回归分析，以研究各州/领地之间的趋势和差异。对死亡率进行年龄、性别以及公立或私立入院情况的风险调整。数据集包括2005/2006财年至2012/2013财年接受肝切除术的患者。
所有类型肝切除术的总体围手术期死亡率为1.6%（201/12562）。围手术期死亡率随时间无显著变化。然而，各州及领地之间存在显著差异，有两个州的主要肝切除术围手术期死亡率显著更高（区域范围：1.3 - 3.8%）。围手术期死亡率随年龄增加而升高，75 - 79岁年龄组的死亡率最高。私立医院的围手术期死亡率低于公立医院。
本研究结果证实，澳大利亚主要肝切除术的总体围手术期死亡率与国际报道的结果相似。全国及各州/领地的围手术期死亡率随时间无显著变化。各州/领地之间的显著差异值得进一步研究。
