TY - JOUR
T1 - Surgeon volume is predictive of 5-year survival in patients with hepatocellular carcinoma after resection
T2 - A population-based study
AU - Lin, Herng Ching
AU - Lin, Chia Chin
PY - 2009/12
Y1 - 2009/12
N2 - Background and Aim: No study has examined associations between physician volume or hospital volume and survival in patients with liver malignancies in the hepatitis B virus-endemic areas such as Taiwan. This study was to examine the effect of hospital and surgeon volume on 5-year survival and to determine whether hospital or surgeon volume is the stronger predictor in patients with hepatocellular carcinoma after hepatic resection in Taiwan. Methods: Using the 1997-1999 Taiwan National Health Insurance Research Database and the 1997-2004 Cause of Death Data File, we identified 2,799 patients who underwent hepatic resection and 1,836 deaths during the 5-year follow-up period. The Cox proportional hazard regressions were performed to adjust for patient demographics, comorbidity, physician, and hospital characteristics when assessing the association of hospital and surgeon volume with 5-year survival. Results: When we examined the effect of physician and hospital volumes separately, both physician and hospital volumes significantly predicted 5-year survival after adjusting for characteristics of patient, surgeon, and hospital. However, after we adjusted for characteristics of physician and hospital, only physician volume remained a significant predictor of the 5-year survival. Conclusions: Physician volume is a stronger predictor of 5-year survival in hepatocellular carcinoma patients receiving hepatic resection.
AB - Background and Aim: No study has examined associations between physician volume or hospital volume and survival in patients with liver malignancies in the hepatitis B virus-endemic areas such as Taiwan. This study was to examine the effect of hospital and surgeon volume on 5-year survival and to determine whether hospital or surgeon volume is the stronger predictor in patients with hepatocellular carcinoma after hepatic resection in Taiwan. Methods: Using the 1997-1999 Taiwan National Health Insurance Research Database and the 1997-2004 Cause of Death Data File, we identified 2,799 patients who underwent hepatic resection and 1,836 deaths during the 5-year follow-up period. The Cox proportional hazard regressions were performed to adjust for patient demographics, comorbidity, physician, and hospital characteristics when assessing the association of hospital and surgeon volume with 5-year survival. Results: When we examined the effect of physician and hospital volumes separately, both physician and hospital volumes significantly predicted 5-year survival after adjusting for characteristics of patient, surgeon, and hospital. However, after we adjusted for characteristics of physician and hospital, only physician volume remained a significant predictor of the 5-year survival. Conclusions: Physician volume is a stronger predictor of 5-year survival in hepatocellular carcinoma patients receiving hepatic resection.
KW - Hepatocellular carcinoma
KW - Hospital volume
KW - Physician volume
KW - Survival
KW - Taiwan
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U2 - 10.1007/s11605-009-0990-8
DO - 10.1007/s11605-009-0990-8
M3 - Article
C2 - 19730957
AN - SCOPUS:71049119837
SN - 1091-255X
VL - 13
SP - 2284
EP - 2291
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 12
ER -