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  1. The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Invited critique.

    Article - En anglais

    Background 

    Volume-outcome relations have been established for several complex therapies.

    However, few studies have examined volume-outcome relations for high-risk procedures in general surgery, such as hepatectomy for hepatocellular carcinoma (HCC).

    Objective 

    To evaluate the relation between hospital volume and outcome for patients undergoing hepatectomy for HCC.

    Design 

    Retrospective cohort study.

    Setting 

    All acute-care hospitals in California.

    Patients 

    Hospital discharge data were analyzed for each patient in California who underwent major hepatic resection for HCC from January 1,1990, through December 31. 1994.

    Hospitals were grouped according to number of hepatectomies performed at each center during the 5-year study.

    Main Outcome Measures 

    Outcome measures included operative mortality and length of hospital stay.

    Regression analyses were used to adjust for differences in patient mix.

    Results 

    Five hundred seven patients underwent hepatectomy for HCC during the study.

    Hepatic resections were performed in 138 hospitals, with an overall inhospital mortality rate of 14.8%. Three quarters patients were treated at hospitals that average 3 or fewer hepatic resections for HCC per year.

    These low-volume providers represent 97.1% of all hospitals treating patients with HCC statewide.

    Significant reductions in risk-adjusted operative mortality rates (22.7% - 9.4% ; P=002. multiple logistic regression) and risk-adjusted length of stay. (...)

    Mots-clés Pascal : Carcinome hépatocellulaire, Facteur prédictif, Postopératoire, Hépatectomie, Survie, Taille, Hôpital, Expérience professionnelle, Equipe soignante, Etude statistique, Homme, Appareil digestif pathologie, Foie pathologie, Tumeur maligne, Chirurgie

    Mots-clés Pascal anglais : Hepatocellular carcinoma, Predictive factor, Postoperative, Hepatectomy, Survival, Size, Hospital, Professional experience, Health care staff, Statistical study, Human, Digestive diseases, Hepatic disease, Malignant tumor, Surgery

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0085884

    Code Inist : 002B25G03. Création : 31/05/1999.