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Outcomes After Resection of Hepatocellular Carcinoma: Intersection of Travel Distance and Hospital Volume

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Journal of Gastrointestinal Surgery

Abstract

Background

Data on the impact of hospital volume and travel distance on patient outcomes after major abdominal surgery remain poorly defined. We sought to characterize the relationship of travel distance, hospital volume, and long-term outcomes of patients undergoing surgical resection of hepatocellular carcinoma (HCC).

Methods

The 2004–2015 National Cancer Database was used to identify patients who underwent resection of HCC. Patients were stratified according to travel distance and hospital volume quartiles, and multivariable regression models were utilized to examine the impact of travel distance, hospital volume, and travel distance/hospital volume on overall survival (OS).

Results

Among the 12,266 patients identified, procedures included wedge/segmental resections (N = 7354, 59.9%), hemi-hepatectomy (N = 4003, 32.6%), and extended hepatectomy (N = 909, 7.5%). Stratifying data into quartiles, travel distance to surgical care was ≤ 5.7 miles (mi), > 5.7–14.2 mi, > 14.2–44.4 mi, and ≥ 44.4 mi, while hospital volume quartiles determined on the hospital level were ≤ 1 case per year, 1.1–4, 4.1–12.5, and ≥ 12.5. On multivariable analysis, increased hospital volume was associated with decreased hazard of mortality (HR 0.69, 95% CI 0.45–0.82, p < 0.001). Travel distance was not significantly associated with hazard of mortality. Furthermore, only hospital volume was associated with mortality (HR 0.67, 95% CI 0.56–0.80, p < 0.001) after controlling for both travel distance and hospital volume.

Conclusions

Only hospital volume was associated with increased hazard of mortality. The benefits of undergoing resection for HCC at a high-volume hospital appear to outweigh the inconvenience of longer travel distances.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Eliza W. Beal, Rittal Mehta, Katiuscha Merath, Diamantis I. Tsilimigras, J. Madison Hyer, Anghela Paredes, Mary E. Dillhoff, Jordan Cloyd, Aslam Ejaz & Timothy M. Pawlik

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  1. Eliza W. Beal
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Contributions

EWB, RM, DIT, AP, KM, MED, JC, AE, and TMP conceived of and designed this work. RM and EWB performed data analysis. EWB drafted the manuscript. EWB, RM, AP, KM, MED, JC, AE, and TMP critically revised the manuscript, provided approval of the final version, and agree to be accountable for all aspects of the work.

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Correspondence to Timothy M. Pawlik.

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Beal, E.W., Mehta, R., Merath, K. et al. Outcomes After Resection of Hepatocellular Carcinoma: Intersection of Travel Distance and Hospital Volume. J Gastrointest Surg 23, 1425–1434 (2019). https://doi.org/10.1007/s11605-019-04233-w

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