2008 Annual Meeting Abstracts

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Purpose: Liver resection is the only curative therapy for hepatic malignancy, both primary and secondary. Despite this, recent trends in the use and outcomes of hepatic resection in Canada are unknown. This study sought to describe patient characteristics and crude outcomes along with patterns of regionalization for hepatic resection in Canada from 1995-2004.
Methods: Discharge data from all hospitals across Canada except Quebec were obtained from the Canadian Institute for Health Information for 1995-2004. All patients undergoing a hepatic resection were identified using ICD 9 and 10 codes. Calculated mortality rates are based on in-hospital deaths according to year and surgical indication. High-volume hospitals were defined as those performing 10 or more procedures per year.
Results: Over the study period, 9912 patients (mean age 59.10) underwent hepatic resection at 247 hospitals. The national age- and sex-adjusted hepatic resection rate per 100 000 people aged ≥ 18 years increased from 3.22 in 1995 to 5.86 in 2004. Patients who underwent resection in the years 1995-1999 had a significantly increased chance of mortality compared to those operated on from 2000-2004 (odds ratio 1.43, 95% confidence interval 1.18-1.73). Rates of hepatic resection for metastases increased by 29% and had outcomes superior to that observed for primary malignancy (mortality rate 2.65% compared to 6.01%, p< 0.0001). The proportion of procedures performed at high-volume hospitals increased from 41.52% in 1995 to 83.53% in 2004.
Conclusions: The rate of hepatic resection in Canada has increased dramatically, especially for metastatic disease. Over the same time period, mortality rates have significantly improved. Our study also demonstrates increasing regionalization likely due to growing evidence that high-volume centers have superior outcomes for complex procedures.

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