Hospital Volume and Post‐Hepatectomy Liver Failure After Major Hepatectomy

BACKGROUND: Post-hepatectomy liver failure (PHLF) following major hepatectomy (MH) increases the risk of morbidity and death. The relationship between institutional MH volume, PHLF, and outcomes is not well characterized. METHODS: Adults undergoing MH from 2014 to 2021 in the ACS NSQIP hepatectomy-targeted database were included. Rates of PHLF were compared based on hospital-level annual MH volume. Multivariable logistic regression evaluated the association between volume, PHLF grade, and outcomes. RESULTS: Across 11,167 patients, PHLF incidence was 3.7% in low-volume, 5.5% in low-medium volume, 6.9% in medium-high volume, 11.8% in high-volume centers (p < 0.001). The adjusted odds ratio (aOR) for morbidity in grade B/C PHLF compared to those without PHLF was elevated in both lower-volume centers (quartiles 1-3), (11.2 7.04-17.70) and in high-volume centers, (8.47 6.06-11.85). CONCLUSION: Higher annual major hepatectomy volume is associated with increased PHLF, which may be a function of complex disease treated at these institutions. PHLF precedes other adverse events affecting both high and low volume institutions. PHLF is an important target for quality improvement.