A new study has found that 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.
Along with Gannon, the other authors are: V. Dombrovskiy, MD, PhD, MPH, UMDNJ-Robert Wood Johnson Medical School; G. Young, MD, PhD, UMDNJ-Robert Wood Johnson Medical School; D. Carpizo, MD, CINJ and UMDNJ-Robert Wood Johnson Medical School; and T.R.Vogel, MD, MPH, UMDNJ-Robert Wood Johnson Medical School.
About The Cancer Institute of New Jersey
The Cancer Institute of New Jersey (www.cinj.org) is the state''s first and only National Cancer Institute-designated Comprehensive Cancer Center dedicated to improving the detection, treatment and care of patients with cancer, and serving as an education resource for cancer prevention. CINJ''s physician-scientists engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. To make a tax-deductible gift to support CINJ, call 732-235-8614 or visit www.cinjfoundation.org. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.
The CINJ Network is comprised of hospitals throughout the state and provides a mechanism to rapidly disseminate important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Memorial Hospital, Carol G. Simon Cancer Center at Overlook Hospital, Cooper University Hospital and Jersey Shore University Medical Center. Affiliate Hospitals: Bayshore Community Hospital, CentraState Healthcare System, JFK Medical Center, Mountainside Hospital, Raritan Bay Medical Center, Robert Wood Johnson University Hospital at Hamilton (CINJ at Hamilton), Saint Peter''s University Hospital, Somerset Medical Center, Southern Ocean County Hospital, The University Hospital/UMDNJ-New Jersey Medical School*, and University Medical Center at Princeton. *Academic Affiliate