National trends in the use and outcomes of hepatic resection

Journal of the American College of Surgeons
Justin B DimickLisa M Colletti

Abstract

Hepatic resection is increasingly performed for primary and metastatic tumors. Reports from tertiary care centers show improved outcomes over time with lower operative mortality rates. The objective of this investigation was to characterize trends in the use and outcomes of hepatic resection in the US during a recent 13-year period. Adult patients with a procedures code for hepatic resection in the Nationwide Inpatient Sample (NIS) from 1988 to 2000 were included. The Nationwide Inpatient Sample is a 20% representative sample of all discharges in the US. Outcomes variables included in-hospital mortality and length of stay. High volume hospitals performed 10 or more (>50th percentile) procedures per year. During the 13-year period, 16,582 patients underwent hepatic resection. The number of procedures performed increased nearly twofold, from 820 per year in 1988 to 1,420 per year in 2000. Similar changes in use were seen for each indication for operation. The overall mortality rate declined from 10.4% (1988 to 1989) to 5.3% (1999 to 2000) during the study period (p < 0.001). The mortality rate was lower at high volume centers than at lower volume centers (5.8% versus 8.9%, p < 0.001), and the decline in mortality over time was gr...Continue Reading

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