Patient Comorbidities Drive High Mortality Rates Associated with Major Liver Resections Irrespective of Hospital Volume

Laurence P. Diggs, John G. Aversa, Timothy L. Wiemken, Sean P. Martin, Justin A. Drake, Samantha M. Ruff, Michael M. Wach, Zachary J. Brown, Andrew M. Blakely, Jeremy L. Davis, Carrie Luu, Jonathan M. Hernandez

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Introduction: Major hepatectomies are utilized to manage primary hepatic malignancies. Reports from high-volume centers (HVCs) with minimal perioperative mortality focus on multiple aspects of perioperative care, although patient-specific factors remain unelucidated. We identified patient factors associated with outcomes and examined whether these contribute to survival differences. Methods: We queried the National Cancer Database (2006-2015) for patients with primary liver malignancies managed with major hepatectomy. Facilities were dichotomized by volume (high volume: >15 hepatectomies/year). Perioperative outcomes were compared based on patient demographic and clinical characteristics as well as center volume. Results: 4263 patients were included with 78.5% receiving care in low-volume centers (LVCs). 90-day postoperative mortality was higher in LVCs vs. HVCs (12% vs. 7.5%; P <.001). Factors associated with undergoing surgery in LVCs included: living in areas with lower income (P =.006) and education (P <.001), having nonprivate insurance (P <.001), residing near the care center (P <.001), and having a comorbidity score (CDS) >1 (P =.014). Patients with CDS ≤ 1 had higher 90-day mortality in LVCs (11.3% vs. 6.6%; P <.001) and had similar outcomes in LVCs and HVCs (15.6% vs. 13.7% P =.6). Patients with CDS > 1 were more likely to receive care in LVCs (16.3% vs. 12.7%; P <.001). Conclusion: Reduced perioperative mortality following major hepatectomy in HVCs is driven by optimal management of patients with low CDS. However, nearly 1 in 5 patients who undergo major hepatectomies have a high CDS and approximately 15% of them succumb in the perioperative period irrespective of the treating centers’ experience.

Original languageEnglish (US)
Pages (from-to)1163-1170
Number of pages8
JournalAmerican Surgeon
Volume87
Issue number7
DOIs
StatePublished - Jul 2021

All Science Journal Classification (ASJC) codes

  • Surgery

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