The Impact of Hospital Volume on Failure to Rescue after Liver Resection for Hepatocellular Carcinoma: Analysis from the HE.RC.O.LE.S. Italian Registry

Francesco Ardito, Felice Giuliante, Marta Maestri, Giuseppe Zimmitti, Anna Maria Antonucci, Federica Romano, S. Famularo, L. Aldrighetti, G. L. Grazi, R. DallaValle, E. Jovine, A. Ruzzenente, G. L. Baiocchi, G. Ercolani, G. Griseri, A. Frena, G. Zanus, M. Crespi, R. Memeo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

1 Citazioni (Scopus)

Abstract

OBJECTIVE: The aim of this study was to evaluate correlation between centers' volume and incidence of failure to rescue (FTR) following liver resection for hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: FTR, defined as the probability of postoperative death among patients with major complication, has been proposed to assess quality of care during hospitalization. Perioperative management is challenging in cirrhotic patients and the ability to recognize and treat a complication may be fundamental to rescue patients from the risk of death. METHODS: Patients undergoing liver resection for HCC between 2008 and 2018 in 18 Centers enrolled in the He.Rc.O.Le.S. Italian register. Early results included major complications (Clavien ≥3), 90-day mortality, and FTR and were analyzed according to center's volume. RESULTS: Among 1935 included patients, major complication rate was 9.4% (8.6%, 12.3%, and 7.0% for low-, intermediate- and high-volume centers, respectively, P = 0.001). Ninety-day mortality rate was 2.6% (3.7%, 4.2% and 0.9% for low-, intermediate- and high-volume centers, respectively, P < 0.001). FTR was significantly higher at low- and intermediate-volume centers (28.6% and 26.5%, respectively) than at high-volume centers (6.1%, P = 0.002). Independent predictors for major complications were American Society of Anesthesiologists (ASA) >2, portal hypertension, intraoperative blood transfusions, and center's volume. Independent predictors for 90-day mortality were ASA >2, Child-Pugh score B, BCLC stage B-C, and center's volume. Center's volume and BCLC stage were strongly associated with FTR. CONCLUSIONS: Risk of major complications and mortality was related with comorbidities, cirrhosis severity, and complexity of surgery. These factors were not correlated with FTR. Center's volume was the only independent predictor related with severe complications, mortality, and FTR.
Lingua originaleEnglish
pagine (da-a)840-846
Numero di pagine7
RivistaAnnals of Surgery
Volume272
DOI
Stato di pubblicazionePubblicato - 2020

Keywords

  • hepatocellular carcinoma
  • Hospitals, Low-Volume
  • failure to rescue
  • center's volume
  • hospital volume
  • major complications
  • mortality
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular
  • Comorbidity
  • Female
  • Hepatectomy
  • Hospital Mortality
  • Humans
  • Italy
  • Liver Neoplasms
  • Male
  • Middle Aged
  • Postoperative Complications
  • Registries
  • Risk Factors
  • Failure to Rescue, Health Care
  • Hospitals, High-Volume
  • liver resection

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