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The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer
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The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer
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Journal Article
The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer
2021
Overview
Background: Laparoscopic liver resection (LLR) offers equivalent oncologic outcomes to open resection while reducing complications, hospital stays and costs in selected patients. However, the constraints of laparoscopy along with the inherent technical challenges of liver resection have slowed LLR uptake. To understand how experience supports LLR uptake, we examined the association between surgeons' liver resection volume and the use of LLR for gastrointestinal cancer. Methods: We identified patients who underwent elective liver resection for gastrointestinal cancer (2007-2019) within a health system with regionalized hepatobiliary surgical services. Surgeons' annual liver resection volume, defined using data from 2 years before patients' index surgery, was dichotomized into low (< 30) and high (> 30) volume informed by restricted cubic splines (RCS). We examined the association between surgeons' annual resection volume and LLR with RCS and modified Poisson regression adjusting for patient, procedure and surgeon factors. Results: Seventy-four surgeons performed 5133 liver resections (median patient age 64 yr; 38.7% female), 17.7% of which were performed laparoscopically. High-volume surgeons cared for 37.3% of patients. Low-volume surgeons performed a median of 18 annual resections (interquartile range [IQR] 12.5-30), whereas high-volume surgeons performed 42 (IQR 36-52.5). High-volume surgeons were more likely to utilize LLR (23.6% v. 17.7%, p < 0.001). After adjustment for patient and surgeon factors, high-volume surgeons remained independently associated with the use of laparoscopy (adjusted relative risk 1.30, 95% confidence interval [CI] 1.14-1.48) and increasing surgeon volume associated with higher LLR probability. Conclusion: Patients cared for by high-volume liver surgeons were 30% more likely to receive LLR over open surgery relative to those cared for by low-volume surgeons after adjustment for patient and surgeon characteristics. This indicates that the use of LLR differs on the basis of surgeons' experience with liver resection. These data are important to direct efforts aimed at optimizing the appropriate use and increasing the uptake of LLR, supporting the improvement of patient outcomes.
Publisher
CMA Impact, Inc
Subject
