Magnin Josephine, Bernard Alain, Cottenet Jonathan, Lequeu Jean-Baptiste, Ortega-Deballon Pablo, Quantin Catherine, Facy Olivier
Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France.
Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, University Hospital of Dijon, Dijon, France.
Br J Surg. 2023 Mar 30;110(4):441-448. doi: 10.1093/bjs/znac458.
This nationwide retrospective study was undertaken to evaluate impact of hospital volume and influence of liver transplantation activity on postoperative mortality and failure to rescue after liver surgery.
This was a retrospective study of patients who underwent liver resection between 2011 and 2019 using a nationwide database. A threshold of surgical activities from which in-hospital mortality declines was calculated. Hospitals were divided into high- and low-volume centres. Main outcomes were in-hospital mortality and failure to rescue.
Among 39 286 patients included, the in-hospital mortality rate was 2.8 per cent. The activity volume threshold from which in-hospital mortality declined was 25 hepatectomies. High-volume centres (more than 25 resections per year) had more postoperative complications but a lower rate of in-hospital mortality (2.6 versus 3 per cent; P < 0.001) and failure to rescue (5 versus 6.3 per cent; P < 0.001), in particular related to specific complications (liver failure, biliary complications, vascular complications) (5.5 versus 7.6 per cent; P < 0.001). Liver transplantation activity did not have an impact on these outcomes.
From more than 25 liver resections per year, rates of in-hospital mortality and failure to rescue declined. Management of specific postoperative complications appeared to be better in high-volume centres.
本全国性回顾性研究旨在评估医院手术量以及肝移植活动对肝切除术后死亡率和抢救失败率的影响。
这是一项利用全国性数据库对2011年至2019年间接受肝切除手术患者进行的回顾性研究。计算出住院死亡率开始下降时的手术活动阈值。医院被分为高手术量中心和低手术量中心。主要结局指标为住院死亡率和抢救失败率。
纳入的39286例患者中，住院死亡率为2.8%。住院死亡率开始下降时的手术量阈值为25例肝切除术。高手术量中心（每年超过25例切除术）术后并发症更多，但住院死亡率（2.6%对3%；P<0.001）和抢救失败率（5%对6.3%；P<0.001）更低，尤其是与特定并发症（肝衰竭、胆系并发症、血管并发症）相关的情况（5.5%对7.6%；P<0.001）。肝移植活动对这些结局无影响。
每年进行超过25例肝切除术后，住院死亡率和抢救失败率下降。高手术量中心对特定术后并发症的处理似乎更好。
