Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

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Background: Many factors cause hospital mortality (HM) after liver transplantation (LT).Methods: We performed a retrospective research in a single center from October 2005 to June 2019. The study included 463 living donor LT patients. They were divided into a no-HM group (n=433, 93.52%) and an HM group (n=30, 6.48%). We used logistic regression analysis to determine how clinical features and surgical volume affected HM. We regrouped patients based on periods of surgical volume and analyzed the clinical features.Results: Multivariate analysis revealed that donor age (OR= 1.050, 95% CI: 1.011– 1.091, p=0.012), blood loss (OR=1.000, 95% CI: 1.000–1.000, p=0.004), and annual surgical volumes being < 30 LTs (OR=2.540, 95% CI: 1.011–6.381, p=0.047) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 the recipient age (p=0.023), donor age (p=0.026), and ABO-incompatible operations (p<0.001) were significantly higher and blood loss (p<0.001), operative time (p<0.001), intensive care unit days (p<0.001), length of stay (p=0.011), rate of re-operation (p<0.001), and HM (p=0.030) were significantly lower compared to when the annual surgical volumes were less than 30.Conclusions: Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.