Abstract：
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.
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.
摘要：
背景：这项全国性的回顾性研究旨在评估医院容量和肝移植活动对肝脏手术后死亡率和抢救失败的影响。
方法：这是一项使用全国数据库对2011年至2019年间接受肝切除术的患者进行的回顾性研究。计算了医院内死亡率下降的手术活动阈值。医院分为高容量和低容量中心。主要结局是院内死亡率和抢救失败。
结果：在39286例患者中，住院死亡率为2.8%。住院死亡率下降的活动量阈值为25例肝切除术。高容量中心（每年切除超过25次）术后并发症较多，但院内死亡率较低（2.6对3％；P<0.001）和抢救失败（5对6.3％；P<0.001），特别是与特定并发症(肝功能衰竭，胆道并发症,血管并发症)(5.5%对7.6%；P<0.001)。肝移植活动对这些结果没有影响。
结论：从每年超过25例的肝切除术中，住院死亡率和抢救失败率下降.在高容量中心，特定术后并发症的管理似乎更好。
方法：这是一项使用全国数据库对2011年至2019年间接受肝切除术的患者进行的回顾性研究。计算了医院内死亡率下降的手术活动阈值。医院分为高容量和低容量中心。主要结局是院内死亡率和抢救失败。
结果：在39286例患者中，住院死亡率为2.8%。住院死亡率下降的活动量阈值为25例肝切除术。高容量中心（每年切除超过25次）术后并发症较多，但院内死亡率较低（2.6对3％；P<0.001）和抢救失败（5对6.3％；P<0.001），特别是与特定并发症(肝功能衰竭，胆道并发症,血管并发症)(5.5%对7.6%；P<0.001)。肝移植活动对这些结果没有影响。
结论：从每年超过25例的肝切除术中，住院死亡率和抢救失败率下降.在高容量中心，特定术后并发症的管理似乎更好。
