{"doi":"10.1177/0003134820973368","title":"Patient Comorbidities Drive High Mortality Rates Associated with Major Liver Resections Irrespective of Hospital Volume","abstract":"Introduction Major hepatectomies are utilized to manage primary hepatic malignancies. Reports from high-volume centers (HVCs) with minimal perioperative mortality focus on multiple aspects of perioperative care, although patient-specific factors remain unelucidated. We identified patient factors associated with outcomes and examined whether these contribute to survival differences. Methods We queried the National Cancer Database (2006-2015) for patients with primary liver malignancies managed with major hepatectomy. Facilities were dichotomized by volume (high volume: >15 hepatectomies/year). Perioperative outcomes were compared based on patient demographic and clinical characteristics as well as center volume. Results 4263 patients were included with 78.5% receiving care in low-volume centers (LVCs). 90-day postoperative mortality was higher in LVCs vs. HVCs (12% vs. 7.5%; P < .001). Factors associated with undergoing surgery in LVCs included: living in areas with lower income ( P = .006) and education ( P < .001), having nonprivate insurance ( P < .001), residing near the care center ( P < .001), and having a comorbidity score (CDS) >1 ( P = .014). Patients with CDS ≤ 1 had higher 90-day mortality in LVCs (11.3% vs. 6.6%; P < .001) and had similar outcomes in LVCs and HVCs (15.6% vs. 13.7% P = .6). Patients with CDS > 1 were more likely to receive care in LVCs (16.3% vs. 12.7%; P < .001). Conclusion Reduced perioperative mortality following major hepatectomy in HVCs is driven by optimal management of patients with low CDS. However, nearly 1 in 5 patients who undergo major hepatectomies have a high CDS and approximately 15% of them succumb in the perioperative period irrespective of the treating centers’ experience.","journal":"The American Surgeon","year":2020,"id":108419,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9176,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":403857,"name":"John G. Aversa","orcid":"0000-0002-0430-6803","position":1,"is_corresponding":false},{"id":433929,"name":"Timothy L. Wiemken","orcid":"0000-0002-8251-3007","position":2,"is_corresponding":false},{"id":281349,"name":"Sean P. Martin","orcid":"0000-0002-6923-947X","position":3,"is_corresponding":false},{"id":381398,"name":"Justin A. Drake","orcid":"0000-0002-2500-7044","position":4,"is_corresponding":false},{"id":474952,"name":"Samantha M. Ruff","orcid":"0000-0001-5275-6705","position":5,"is_corresponding":false},{"id":381399,"name":"Michael M. Wach","orcid":"0000-0002-7686-6076","position":6,"is_corresponding":false},{"id":239658,"name":"Zachary J. Brown","orcid":"0000-0002-8347-9197","position":7,"is_corresponding":false},{"id":381400,"name":"Andrew M. Blakely","orcid":"0000-0002-5013-3851","position":8,"is_corresponding":false},{"id":243365,"name":"Jeremy L. Davis","orcid":"0000-0002-6334-6936","position":9,"is_corresponding":false},{"id":497203,"name":"Carrie Luu","orcid":"0000-0002-5252-694X","position":10,"is_corresponding":false},{"id":106391,"name":"Jonathan M. Hernandez","orcid":"0000-0001-7529-0557","position":11,"is_corresponding":false},{"id":243442,"name":"Laurence P. Diggs","orcid":null,"position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-18T23:12:43.081337Z","pmid":"33345554","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}