Postoperative Complication Rates After Hepatic Resection in Maryland Hospitals

摘要: Hypothesis High-volume centers provide superior quality care and therefore have a lower incidence of postoperative complications. Design Observational statewide administrative database. Setting State Maryland, nonfederal acute-care hospital (n = 52), performing liver resection 35). Patients All patients discharged after undergoing hepatic from 1994 to 1998 (N 569). Main Outcome Measures Two sequential analyses using multiple logistic regression in-hospital mortality were performed determine the relative importance preoperative case-mix Results The overall rate was 4.8% significantly in high-volume hospitals (2.8%) than low-volume (10.2%) ( P .02). Having surgery at associated with increased rates several complications: reintubation (relative risk [RR], 2.5; 95% CI, 1.8-3.4), pulmonary failure (RR, 2.3; 1.6-3.5), pneumonia 0.35; 1.0-5.6), acute renal 2.0; 1.1-3.7), myocardial infarction 2.6; 1.2-5.9), aspiration 1.4; 0.9-2.0). When considering all other factors statistical methods, volume no longer mortality. Conclusions who undergo are higher complications death those same operation hospitals. empirical difference between outcomes high- seems be due variation