D. A. Hashimoto1, Y. J. Bababekov2, S. M. Stapleton2, I. H. Marks2, K. D. Lillemoe1, D. C. Chang2, P. A. Vagefi1 1Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 2Massachusetts General Hospital,Codman Center For Clinical Effectiveness In Surgery,Boston, MA, USA
Introduction: There have been considerable improvements in surgical technique and perioperative care in the last decade with respect to hepatic resection for hepatobiliary diseases. As a result, decreased post-operative mortality has been described at the institutional level. However, inpatient mortality trends following hepatic resection have yet to be assessed on a population level.
Methods:
The New York (NY) Statewide Planning and Research Cooperative System (SPARCS) inpatient database was utilized. All patients over the age of 18 years who underwent wedge hepatectomy or lobectomy from 2000-2014 were included. Trauma and recipient hepatectomy were excluded. Adjusted analysis accounted for age, race, payer status, Charlson Comorbidity Index (CCI), cirrhosis, viral/alcoholic hepatitis, hepatic malignancy (primary vs. secondary tumor), need for biliary-enteric reconstruction, and hospital hepatectomy volume.
Results:
A total of 13,467 hepatectomies were performed from 2000-2014 in the state of NY with a mean inpatient mortality of 2.35% (± 15.1% SD). Of these, 86.6% of hepatectomies were performed at academic centers (hospitals with a surgical residency). Inpatient mortality decreased from a rate of 3.69% in 2000 to 1.98% in 2014 (p<0.0001). Adjusted analysis demonstrated a decreasing trend in mortality from 2000 to 2014 with sustained significance reached in 2009 (OR 0.29, p=0.001) (Figure 1).
Subset analysis revealed similar findings for patients in academic centers, with secondary tumors, or with CCI>3 (all p<0.001). Independent predictors of mortality included age>70 years, male gender, Medicare payer status, primary liver tumor, and need for biliary-enteric reconstruction. Hepatectomy at an academic center (OR 0.62, p=0.002) and female gender (OR 0.67, p=0.001) were protective against mortality.
Conclusion:
This study demonstrates at the state population level that inpatient mortality after hepatectomy has improved over the time period 2000-2014. Increased survival may be due to a combination of advancements in operative and perioperative care. In-depth analyses of surgical care at hospitals in NY may reveal state wide quality improvement practices that led to reduced inpatient mortality after hepatic resections. Such measures could serve as a model for other health systems.
