[Investigations on fatalities due to liver resection in Germany : Evaluation of the German Society for General and Visceral Surgery certification regulations for liver centers based on routine diagnosis-related groups data].
BACKGROUND : The German Society for General and Visceral Surgery (DGAV) offers surgical departments certification as a specialist center for surgical treatment of liver diseases. Annual minimum case volumes have been defined for which, however, no empirical sources are available. OBJECTIVE : This study examined the defined hospital volume requirements in the DGAV certification regulations for the field of surgical treatment of liver diseases with respect to in-hospital mortality. METHODS : Based on the nationwide German hospital billing data (diagnosis-related groups, DRG statistics), the institutions were classified according to the criteria (minimum number of cases and TV30 criterion) of the DGAV certification regulations and the hospital mortality was compared. In addition, the relationship between the annual procedure volumes of institutes and in-hospital mortality was examined separately for the various types of interventions (interventions, anatomical liver resections, resection of more than three segments, resection of the fork of the hepatic duct). RESULTS : Hospitals that met the requirements for higher certification levels had a higher hospital mortality (competence centers 3.03%, 95% confidence interval, CI: 2.24; 3.65, reference centers 4.26%, 95% CI: 3.28; 5.25, centers of excellence 6.13%, 95% CI: 5.56; 6.70). The separate evaluation of the types of intervention resulted in different case number limits with respect to the relationship between procedure volume and hospital mortality, above which hospital mortality is significantly lower than that defined in the DGAV certification. CONCLUSIONS : The findings indicate that the existing certification criteria for the minimum number of cases and the TV30 criterion should be readjusted.