Inter-surgeon variability is associated with likelihood to undergo minimally invasive hepatectomy and postoperative mortality. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Tsilimigras, Diamantis I.; Hyer, J. Madison; Chen, Qinyu; Diaz, Adrian; Paredes, Anghela Z.; Moris, Dimitrios; Dillhoff, Mary; Cloyd, Jordan M.; Beane, Joal D.; Tsung, Allan; Ejaz, Aslam; Pawlik, Timothy M.
• Is Part Of: HPB. Volume 23:Issue 6(2021)
• Page Start: 840
• Page End: 846
• Publication Date: 2021-06
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2020.11.003
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Introduction: Minimally invasive liver surgery (MILS) has been increasingly adopted in clinical practice; yet, inter-surgeon variability in operative approach (MILS vs. open), as well as the impact of providers on the likelihood of undergoing MILS have not been well characterized. Methods: The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent hepatectomy between 2013 – 2017. The impact of patient- and procedure- related factors on the likelihood of MILS was investigated. Results: Overall 12, 110 (91.6%) patients underwent open liver resection, while 1, 112 (8.4%) patients had MILS. Based on total MILS volume, surgeons were categorized into average (1–3 cases), above average (4–7 cases) and high (>8 or more cases) MILS volume surgeons. While male patients (OR = 0.85, 95%CI 0.75–0.97) were less likely to undergo MILS, patients operated on more recently (year 2017; OR = 1.72, 95%CI 1.38–2.14) for a cancer indication (OR = 1.23, 95%CI 1.05–1.42) had a higher chance of MILS. After controlling for patient- and procedure-related characteristics, there was almost a two-fold variation in the odds that a patient underwent MILS versus open hepatectomy based on the individual surgeon provider (MOR = 1.75, 95%CI 1.48–1.99). Patients who had a MILS performed by a high-volume MILS surgeon had 36% lower odds of death within 90-days (OR = 0.64, 95%CI 0.51–0.79). Conclusion: The likelihood of undergoing MILS, as well as post-operative mortality, was heavily influenced by the individual surgeon provider rather than patient- or procedure-related factors.