| アブストラクト | AIM: The present study aimed to conduct a nationwide investigation on the relationship between hospital volume and outcomes following liver resection in Japan. We also discuss health policy implications of the results. METHODS: Using the Japanese Diagnosis Procedure Combination database, we identified 18 046 patients who underwent hepatic resection between July and December 2007-2009. Patients were subdivided into hospital-volume quartiles: very low- (<18/year), low- (18-35), high- (36-70) and very high-volume groups (>70). Multivariate logistic regression analysis for in-hospital mortality within 30 days of surgery was performed to analyze adjusted effects of various factors. RESULTS: Patients in the very high-volume group had a higher Charlson Comorbidity Index (P < 0.001) than those in the very low-volume group. Very low-volume hospitals were significantly less likely to perform extended lobectomy than very high-volume hospitals (5.4% vs 17.6%, P < 0.001). Crude in-hospital mortality within 30 days of surgery was 1.1% (0.6%, 0.8%, 1.9% and 3.0% for limited resection, segmentectomy, lobectomy and extended lobectomy, respectively). With reference to the very low-volume group, risk-adjusted odds ratios (95% confidence intervals) of low-, high- and very high-volume groups for overall mortality were 0.70 (0.48-1.02; P = 0.060), 0.52 (0.34-0.81; P = 0.004) and 0.16 (0.09-0.30; P < 0.001), respectively. CONCLUSION: There is a linear trend between higher hospital volume and lower in-hospital mortality of liver resection in Japan, particularly for lobectomy and extended lobectomy. Based on these results, regionalization of lobectomy and extended lobectomy in high-volume centers could be effective for reducing postoperative mortality. |
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| ジャーナル名 | Hepatology research : the official journal of the Japan Society of Hepatology |
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| 投稿日 | 2012/5/3 |
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| 投稿者 | Yasunaga, Hideo; Horiguchi, Hiromasa; Matsuda, Shinya; Fushimi, Kiyohide; Hashimoto, Hideki; Ohe, Kazuhiko; Kokudo, Norihiro |
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| 組織名 | Departments of Health Management and Policy Medical Informatics and Economics;Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Artificial;Organ and Transplantation Division, Graduate School of Medicine Department of;Health Economics and Epidemiology Research, School of Public Health, The;University of Tokyo Department of Health Policy and Informatics, Tokyo Medical;and Dental University Graduate School of Medicine, Tokyo Department of Preventive;Medicine and Community Health, University of Occupational and Environmental;Health, Fukuoka, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/22548757/ |
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