Regionalization of Hepatic Resections Is Associated with Increasing Disparities among Some Patient Populations in Use of High-Volume Providers

BackgroundThe goal of our study was to determine the temporal trends in provider volume for liver resection procedures.Study DesignThe Nationwide Inpatient Sample database for 1988 through 2003 was used to determine temporal trends in hospital and surgeon volume of liver resection procedures. We also examined whether these trends in provider volume were associated with any changes in postoperative outcomes or in patients' access to high-volume providers.ResultsRegionalization of liver resection procedures to high-volume surgeons and hospitals has been occurring since 1988 and, in the most recent time period assessed, 25.8% of patients underwent hepatic resection by high-volume surgeons (≥ 17 procedures per year) and 29.9% of patients underwent resection in high-volume hospitals (≥ 45 procedures per year). Unadjusted mortality data suggest that these trends might be associated with a strengthening of the inverse relationship between hospital volume of hepatic resection and postoperative mortality and with an increasing disparity for some patient populations in use of high-volume hospitals.ConclusionsRegionalization of liver resections is occurring at both the level of the individual surgeon and the hospitals where these procedures are performed. These trends in provider volume might be associated with increasing discrepancies in outcomes and patient demographics among different volume categories of hospitals.