Postoperative complications more likely to occur at low-volume institutions

The frequency of post-operative complications following surgery for liver cancer is associated with a hospital having a low volume of liver surgery. Investigators at The Cancer Institute of New Jersey (CINJ) are presenting that finding at the 63rd Annual Society of Surgical Oncology Symposium taking place this week in St. Louis. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

Previous analyses of state and national databases have documented institutional volume-related death rates at low-volume hospitals for this type of surgery; however, a causal relationship has not been determined. In this current study, the team analyzed 9,289 cases between 1998 and 2007 from the Nationwide Inpatient Sample database. Patients were more than 18 years old and underwent elective surgical removal of a portion of their liver due to malignancy. A threshold of 20 annual liver surgeries was used in each hospital to separate low-volume facilities from high-volume facilities. Investigators reviewed postoperative complications such as sepsis and hemorrhaging, as well as problems with the liver, lungs, heart, and bladder. Also taken into account were socio-demographic factors such as age, gender and race among other variables.

What they found was that patients at low-volume hospitals experienced at least one of the analyzed postoperative complications more often than at high-volume facilities. Specifically, hemorrhagic, septic and lung complications were more likely to occur at low-volume institutions. However, overall, the rate of liver complications was lower at these facilities. When mortality was analyzed, it was found that patients who underwent liver cancer surgery at low-volume hospitals were 1.4 times as likely to die as patients who had the procedure at a high-volume institution.

Christopher J. Gannon, MD, surgical oncologist at CINJ and assistant professor of surgery at UMDNJ-Robert Wood Johnson Medical School, is the lead investigator. "This new data is significant in that it could be utilized in low-volume facilities to investigate systems problems once complications occur. This information also has benefit for high-volume hospitals, as it could also be used in centralizing liver cancer care," he noted.