Hospital Volume and Post-Hepatectomy Liver Failure After Major Hepatectomy

Area of Science:

• Hepatobiliary surgery
• Surgical outcomes research
• Health services research

Background:

• Post-hepatectomy liver failure (PHLF) is a significant complication after major hepatectomy (MH), increasing morbidity and mortality.
• The impact of hospital volume on PHLF incidence and patient outcomes after MH is not well understood.

Purpose of the Study:

• To investigate the relationship between institutional annual major hepatectomy (MH) volume and the incidence of post-hepatectomy liver failure (PHLF).
• To evaluate the association between MH volume, PHLF severity, and patient outcomes, including morbidity.

Main Methods:

• Analysis of adult patients undergoing MH between 2014-2021 using the ACS NSQIP hepatectomy-targeted database.
• Comparison of PHLF rates across different hospital-level annual MH volumes (low, low-medium, medium-high, high).
• Multivariable logistic regression to assess the association of volume with PHLF grade and outcomes.

Main Results:

• PHLF incidence increased significantly with higher annual MH volume, ranging from 3.7% in low-volume to 11.8% in high-volume centers (p < 0.001).
• Patients with grade B/C PHLF had significantly elevated odds of morbidity compared to those without PHLF, regardless of hospital volume.
• The adjusted odds ratio for morbidity in grade B/C PHLF was 11.2 in lower-volume centers and 8.47 in high-volume centers.

Conclusions:

• Higher annual MH volume is associated with increased PHLF rates, potentially due to the complexity of cases treated at high-volume centers.
• PHLF is a critical precursor to other adverse events and impacts outcomes in both high and low-volume institutions.
• PHLF represents a crucial target for quality improvement initiatives in hepatectomy care.