TY - JOUR
T1 - Volume-Outcome Associations after Major Hepatectomy for Hepatocellular Carcinoma
T2 - A Nationwide Taiwan Study
AU - Lu, Chih Cheng
AU - Chiu, Chong Chi
AU - Wang, Jhi Joung
AU - Chiu, Yu Hsien
AU - Shi, Hon Yi
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/6
Y1 - 2014/6
N2 - Objective: The objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC). Methods: This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test. Results: The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001). Conclusions: The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.
AB - Objective: The objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC). Methods: This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test. Results: The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001). Conclusions: The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.
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U2 - 10.1007/s11605-014-2513-5
DO - 10.1007/s11605-014-2513-5
M3 - Article
C2 - 24733257
AN - SCOPUS:84901334122
VL - 18
SP - 1138
EP - 1145
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 6
ER -