Liver surgery may be safer in high-volume hospitals

Reviewed by Emily Henderson, B.Sc.Feb 7 2023

A new paper in the British Journal of Surgery, published by Oxford University Press, finds that patients undergoing liver surgery fare better in higher-volume hospitals; their mortality rates are lower.

Liver surgery is the standard treatment for most patients with primary and secondary liver tumors. Although postoperative mortality after liver surgery is rare, lower than 5%, it can be as high as 20% depending on the specific surgical procedure and where doctors perform the surgery.

Hospital volume influences postoperative complications after complex digestive surgical procedures, but the relationship is unclear. While performing more surgeries may mean overworked staff and rushed procedures higher volume may also mean greater efficiency and greater staff experience. Until now researchers have not investigated the impact of transplant activity in a center on outcomes well.

Researchers here investigated records of more than 39,000 patients who underwent liver surgery in France. They included national data from the French national administrative prospective database, which included 88% of French hospitals performing liver surgery in total. The investigators looked into hospital care for all patients who underwent liver resection between 2011 and December 2019.

The researchers found that patients who had liver surgeries in hospitals that performed more than 25 such surgeries a year were less likely to die after the surgery, either in the hospital immediately following the surgery or within six months of the procedure.

Among 39, 286 patients included, the in-hospital mortality rate was 2.8%, with 1090 deaths. While patients in high-volume hospitals were more likely to suffer from infections after the procedures (14.8% vs 12.7% in lower-volume hospitals), they were less likely to die, 2.6% vs 3%. This was particularly true with regard to liver failure, biliary complications, and vascular complications.

The researchers here believe that higher-volume medical centers are better at managing complications from liver operations "Liver surgery is safer in high-volume medical centers," said the paper's lead author, Josephine Magnin. This is likely due to better technical equipment and dedicated multidisciplinary teams in these establishments.