Mortality following liver resection in US medicare patients: Does the presence of a liver transplant program affect outcome?

BACKGROUND: Hepatic resection is a complicated procedure, at times associated with significant morbidity. Liver transplantation programs may improve outcomes following resective liver surgery at the institutional level by a number of means, including: availability of ancillary services and personnel, specialized critical care, and added surgical expertise. OBJECTIVES: To determine if the presence of a liver transplant program at a center improves outcomes following hepatic resection when compared to centers without an associated liver transplant program. METHODS: Using data from the national Medicare claims database, 30-day mortality following all hepatic resections performed over a 2-year period (1999, 2000) were studied. Regression techniques were used to assess the relationship between mortality at centers with an associated liver transplant program in comparison to those without, while controlling for potential confounding factors. RESULTS: The proportion of patients dying within 30 days among 4,661 patients that underwent hepatic resection was 6.65%. Factors that did increase the risk of dying after hepatic resection included: urgent or emergent surgery (vs. elective), primary liver cancer (vs. metastatic), male sex, increasing comorbidity score, low hospital volume, and extent of surgery. The presence of a liver transplant program within a center was not associated with any improvement in mortality. CONCLUSION: At an institutional level, the presence of a liver transplant program was not associated with decreased 30-day mortality following hepatic resection.