To determine whether the incidence of post-hepatectomy liver failure (PHLF) differs based on hospital major hepatectomy (MH) volume and to evaluate the relationship between PHLF and other 30-day outcomes at both high and low-volume centers.
Approach:
Data Source: Retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Database (ACS NSQIP) from 2014 to 2021.
Inclusion and Exclusion: Included adult patients undergoing elective major hepatectomy; excluded non-major and emergent cases.
Volume Tier Assignment: Hospitals categorized into quartiles based on annual major hepatectomy volume.
Predictor Variables: Analyzed patient demographics, disease state, and hepatectomy-specific variables.
Outcomes: Primary outcomes included PHLF and morbidity after PHLF; secondary outcomes included 30-day mortality, readmission, length of stay, return to operating room, and need for invasive interventions.
Key Findings:
The incidence of PHLF varies significantly based on hospital caseload.
High-volume centers demonstrate lower rates of PHLF compared to low-volume centers.
PHLF is associated with increased morbidity and adverse 30-day outcomes.
Interpretation:
Limitations:
Retrospective design may introduce selection bias.
Data limited to ACS NSQIP may not capture all relevant variables affecting outcomes.
by Xane D. Peters, Brian C. Brajcich, Bona Ko, Catherine Valukas, Lauren M. Janczewski, Clifford Y. Ko, Ryan P. Merkow, Henry A. Pitt, David J. Bentrem
