Department of Health Sciences, University of Piemonte Orientale, Novara, 28100, Italy.
Department of Surgery, University Maggiore Hospital della Carità, Corso Mazzini 18, Novara, 28100, Italy.
Langenbecks Arch Surg. 2024 Jul 10;409(1):211. doi: 10.1007/s00423-024-03398-6.
Whether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume.
This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry "Piano Nazionale Esiti" (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added.
6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively).
High-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight.
医院手术量是否影响肝胆外科患者的预后，以及此类手术的集中化是否合理，仍有待研究。本研究旨在分析意大利肝脏手术的结果与医院手术量的关系。
这是一项全国性的回顾性观察研究，基于 2023 年国家意大利登记处“国家结果计划”（PNE）收集的数据进行，其中包括 2022 年所有肝脏手术。结果测量指标为病例量和 30 天死亡率。医院分为超高容量（H-Vol）、中高容量（I-Vol）、低容量（L-Vol）和超低容量（VL-Vol）。还对集中化过程和结果测量指标进行了综述。
2022 年，327 家医院共进行了 6126 例肝脏肿瘤切除术。30 天死亡率为 2.2%。14 家 H-Vol、19 家 I-Vol、31 家 L-Vol 和 263 家 VL-Vol 医院的 30 天死亡率分别为 1.7%、2.2%、2.6%和 3.6%（P<0.001）；220 家（83%）医院的手术量少于 10 例，78 家（29%）医院在 2022 年仅进行了 1 例手术。考虑到地理大区，意大利北部肝脏切除术的中位数高于中部和南部（分别为 57%、23%和 20%）。
高手术量与肝胆外科手术后的良好预后相关。需要进一步研究以详细了解与死亡率相关的因素。集中化过程应重新设计和监督。
