Ghandour Bachir, Kaplan David E, Mahmud Nadim
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Gastroenterol. 2025 Jan 21;120(9):2186-2189. doi: 10.14309/ajg.0000000000003329.
Patients with cirrhosis have increased surgical risk and require care team expertise. We explored the association between center cirrhosis surgical volume and postoperative mortality in a large VA data set. In this retrospective cohort study of 14,500 major surgeries in patients with cirrhosis, we found in adjusted analysis that high-volume centers (>16 surgeries in past year) had a 36% reduced hazard of postoperative mortality through 90 days vs low-volume centers (<9 surgeries in past year; hazard ratio 0.64, 95% confidence interval 0.43-0.94, P = 0.02). These findings demonstrate the importance of triaging patients with cirrhosis to high-volume centers for major surgery when feasible.
肝硬化患者手术风险增加，需要护理团队的专业知识。我们在一个大型退伍军人事务部（VA）数据集中探讨了中心肝硬化手术量与术后死亡率之间的关联。在这项对14500例肝硬化患者进行的大型手术的回顾性队列研究中，我们在调整分析中发现，高手术量中心（过去一年手术量>16例）与低手术量中心（过去一年手术量<9例）相比，术后90天内死亡风险降低了36%（风险比0.64，95%置信区间0.43 - 0.94，P = 0.02）。这些发现表明，在可行的情况下，将肝硬化患者分诊至高手术量中心进行大手术非常重要。
