PDF(Pubmed)
Abstract：
OBJECTIVE: Whether hospital volume affects outcome of patients undergoing hepatobiliary surgery, and whether the centralization of such procedures is justified remains to be investigated. The aim of this study was to analyze the outcome of liver surgery in Italy in relationship of hospital volume.
METHODS: This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry \"Piano Nazionale Esiti\" (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added.
RESULTS: 6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively).
CONCLUSIONS: High-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight.
METHODS: This is a nationwide retrospective observational study conducted on data collected by the National Italian Registry \"Piano Nazionale Esiti\" (PNE) 2023 that included all liver procedures performed in 2022. Outcome measure were case volume and 30-day mortality. Hospitals were classified as very high-volume (H-Vol), intermediate-volume (I-Vol), low-volume (L-Vol) and very low-volume (VL-VoL). A review on centralization process and outcome measures was added.
RESULTS: 6,126 liver resections for liver tumors were performed in 327 hospitals in 2022. The 30-day mortality was 2.2%. There were 14 H-Vol, 19 I-Vol, 31 L-Vol and 263 VL-Vol hospitals with 30-day mortality of 1.7%, 2.2%, 2.6% and 3.6% respectively (P < 0.001); 220 centers (83%) performed less than 10 resections, and 78 (29%) centers only 1 resection in 2022. By considering the geographical macro-areas, the median count of liver resection performed in northern Italy exceeded those in central and southern Italy (57% vs. 23% vs. 20%, respectively).
CONCLUSIONS: High-volume has been confirmed to be associated to better outcome after hepatobiliary surgical procedures. Further studies are required to detail the factors associated with mortality. The centralization process should be redesigned and oversight.
摘要：
目的：医院容量是否影响肝胆手术患者的预后，这些程序的集中是否合理还有待调查。这项研究的目的是分析意大利肝脏手术的结果与医院数量的关系。
方法：这是一项全国性的回顾性观察研究，对意大利国家登记处“PianoNazionaleEsiti”（PNE）2023收集的数据进行了研究，其中包括2022年进行的所有肝脏手术。结果测量为病例量和30天死亡率。医院被归类为高容量（H-Vol），中间体积(I-Vol)，低容量（L-Vol）和非常低的体积（VL-VOL）。增加了对集中过程和结果措施的审查。
结果：2022年，327家医院进行了6,126例肝肿瘤切除手术。30天死亡率为2.2%。有14个H-Vol,19I-Vol,31家L-Vol医院和263家VL-Vol医院，30天死亡率为1.7%，2.2%,2.6%和3.6%(P<0.001);220个中心(83%)切除少于10次,2022年，78个（29%）中心仅切除1次。通过考虑地理宏观区域，在意大利北部进行的肝切除的中位数计数超过了意大利中部和南部（57％vs.23%vs.20%,分别)。
结论：已证实大量手术与肝胆外科手术后更好的结果相关。需要进一步的研究来详细说明与死亡率相关的因素。应该重新设计和监督集中化进程。
方法：这是一项全国性的回顾性观察研究，对意大利国家登记处“PianoNazionaleEsiti”（PNE）2023收集的数据进行了研究，其中包括2022年进行的所有肝脏手术。结果测量为病例量和30天死亡率。医院被归类为高容量（H-Vol），中间体积(I-Vol)，低容量（L-Vol）和非常低的体积（VL-VOL）。增加了对集中过程和结果措施的审查。
结果：2022年，327家医院进行了6,126例肝肿瘤切除手术。30天死亡率为2.2%。有14个H-Vol,19I-Vol,31家L-Vol医院和263家VL-Vol医院，30天死亡率为1.7%，2.2%,2.6%和3.6%(P<0.001);220个中心(83%)切除少于10次,2022年，78个（29%）中心仅切除1次。通过考虑地理宏观区域，在意大利北部进行的肝切除的中位数计数超过了意大利中部和南部（57％vs.23%vs.20%,分别)。
结论：已证实大量手术与肝胆外科手术后更好的结果相关。需要进一步的研究来详细说明与死亡率相关的因素。应该重新设计和监督集中化进程。
