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Impact of Surgeon Training on Outcomes After Resective Hepatic Surgery

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Higher hospital and surgeon volumes have been associated with improved outcomes after hepatic resection. Subspecialty training has not previously been associated with improved outcomes after hepatic resection. The objective of this study was to determine what effects, if any, surgeon’s volume and training had on the outcomes after hepatic resection.

Methods

Administrative procedure codes were used to identify all adult patients from the fiscal year 1991–1992 to 2003–2004 who underwent a hepatic resection in two large urban health regions in Canada (Calgary and Capital health regions). The primary outcomes were operative mortality and postoperative complications.

Results

There were 1107 hepatic resections in the stated time period performed by a total of 72 surgeons. There were 66 deaths, resulting in an in-hospital mortality rate of 6.0%, and an overall complication rate of 46%. Statistically significant predictors of operative mortality were: urgency of admission, diagnosis of primary hepatic malignancy, extent of resection, and increasing burden of comorbid medical illness. Surgeon training along with patient’s sex, the urgency of admission, diagnosis of primary hepatic malignancy, extent of resection, and increasing comorbidity were predictive of postoperative complications.

Conclusions

This study found surgeon training to be highly predictive of postoperative complications after hepatic resection.

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Acknowledgments

E.D. is a population health investigator with the Alberta Heritage Foundation for Medical Research (AHFMR) and is supported by a New Investigator grant from the Canadian Institute for Health Research. Also supported by an Establishment Grant from the AHFMR and a grant from the Center for the Advancement of Health in Calgary, Alberta. W.G. is supported by a Health Senior Scholar grant from the AHFMR.

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Authors and Affiliations

  1. Department of Surgery, University of Calgary, Calgary, Alberta, Canada

    Andrew McKay MD, FRCSC, Isabelle You MSc, Rene Lafreniere MD, FRCSC, Francis Sutherland MD, FRCSC & Elijah Dixon MD, MSc, BSc, FRCSC, FACS

  2. Department of Surgery, University of Alberta, Alberta, Canada

    David Bigam MD, FRCSC

  3. Department of Oncology, University of Calgary, Calgary, Alberta, Canada

    Rene Lafreniere MD, FRCSC, Francis Sutherland MD, FRCSC & Elijah Dixon MD, MSc, BSc, FRCSC, FACS

  4. Department of Community Health Sciences, Tom Baker Cancer Centre, University of Calgary, 1331–29th Street NW, Calgary, Alberta, Canada, T2N 4N2

    Isabelle You MSc, William Ghali MD, MPH, FRCPC & Elijah Dixon MD, MSc, BSc, FRCSC, FACS

Authors
  1. Andrew McKay MD, FRCSC
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  2. Isabelle You MSc
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  3. David Bigam MD, FRCSC
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  4. Rene Lafreniere MD, FRCSC
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  5. Francis Sutherland MD, FRCSC
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  6. William Ghali MD, MPH, FRCPC
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  7. Elijah Dixon MD, MSc, BSc, FRCSC, FACS
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Corresponding author

Correspondence to Elijah Dixon MD, MSc, BSc, FRCSC, FACS.

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McKay, A., You, I., Bigam, D. et al. Impact of Surgeon Training on Outcomes After Resective Hepatic Surgery. Ann Surg Oncol 15, 1348–1355 (2008). https://doi.org/10.1245/s10434-008-9838-9

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  • DOI: https://doi.org/10.1245/s10434-008-9838-9

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