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10.1245/s10434-008-9838-9
Annals of Surgical Oncology 15:1348-1355 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Impact of Surgeon Training on Outcomes After Resective Hepatic Surgery

Andrew McKay, MD, FRCSC1, Isabelle You, MSc1,4, David Bigam, MD, FRCSC2, Rene Lafreniere, MD, FRCSC1,3, Francis Sutherland, MD, FRCSC1,3, William Ghali, MD, MPH, FRCPC4 and Elijah Dixon, MD, MSc, BSc, FRCSC, FACS1,3,4

1 Department of Surgery, University of Calgary, Calgary, Alberta, Canada
2 Department of Surgery, University of Alberta, Alberta, Canada
3 Department of Oncology, University of Calgary, Calgary, Alberta, Canada
4 Department of Community Health Sciences, Tom Baker Cancer Centre, University of Calgary, 1331–29th Street NW, Calgary, Alberta, Canada T2N 4N2

Correspondence: Address correspondence and reprint requests to: Elijah Dixon, MD, MSc, BSc, FRCSC, FACS; E-mail: Elijah.dixon{at}calgaryhealthregion.ca

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.

Key Words: Liver surgery • Hepatectomy • Surgeon training • Outcome • Postoperative complications






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