Mortality after liver surgery in Germany

Background Mortality rates after liver surgery are not well documented in Germany. More than 1000 hospitals offer liver resection, but there is no central regulation of infrastructure requirements or outcome quality. Methods Hospital mortality rates after liver resection were analysed using the standardized hospital discharge data (Diagnosis-Related Groups, ICD-10 and German operations and procedure key codes) provided by the Research Data Centre of the Federal Statistical Office and Statistical Offices of the Lander in Wiesbaden, Germany. Results A total of 110 332 liver procedures carried out between 2010 and 2015 were identified. The overall hospital mortality rate for all resections was 5 center dot 8 per cent. The mortality rate among 17 574 major hepatic procedures was 10 center dot 4 per cent. Patients who had surgery for colorectal liver metastases (CRLMs) had the lowest mortality rate among those with malignancy (5 center dot 5 per cent), followed by patients with gallbladder cancer (7 center dot 1 per cent), hepatocellular carcinoma (9 center dot 3 per cent) and intrahepatic cholangiocarcinoma (11 center dot 0 per cent). Patients with extrahepatic cholangiocarcinoma had the highest mortality rate (14 center dot 6 per cent). The mortality rate for extended hepatectomy was 16 center dot 2 per cent and the need for a biliodigestive anastomosis increased this to 25 center dot 5 per cent. Failure to rescue after complications led to mortality rates of more than 30 per cent in some subgroups. There was a significant volume-outcome relationship for CRLM surgery in very high-volume centres (mean 26-60 major resections for CRLMs per year). The mortality rate was 4 center dot 6 per cent in very high-volume centres compared with 7 center dot 5 per cent in very low-volume hospitals (odds ratio 0 center dot 60, 95 per cent c.i. 0 center dot 42 to 0 center dot 77; P < 0 center dot 001). Conclusion This analysis of outcome data after liver resection in Germany suggests that hospital mortality remains high. There should be more focused research to understand, improve or justify factors leading to this result, and consideration of centralization of liver surgery.