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.
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。