Laparoscopic partial hepatectomy is cost-effective when performed in high volume centers: A five state analysis.
BACKGROUND
Prior studies comparing the efficacy of laparoscopic (LHR) and open hepatic resection (OHR) have not evaluated inpatient costs.


METHODS
We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Databases to identify patients undergoing hepatic resection between 2010 and 2014.


RESULTS
10,239 patients underwent hepatic resection. 865 (8%) underwent LHR and 9374 (92%) underwent OHR. On adjusting for hospital volume, patients undergoing LHR had a lower risk of respiratory (OR 0.64, 95% CI [0.52, 0.78]), wound (OR 0.48; 95% CI [0.29, 0.79]) and hematologic (OR 0.57; 95% CI [0.44, 0.73]) complication as well as a lower risk of being in the highest quartile of cost (0.58; 95% CI [0.43, 0.77]) than those undergoing OHR. Patients undergoing LHR in very high volume (>314 hepatectomies/year) centers had lower risk-adjusted 90-day aggregate costs of care than those undergoing OHR (-$8022; 95% CI [-$11,732, -$4311).


DISCUSSION
Laparoscopic partial hepatectomy is associated with lower risk of postoperative complication than OHR. This translates to lower aggregate costs in very high-volume centers.
['Eguia|Emanuel|E|', 'Sweigert|Patrick J|PJ|', 'Li|Ruojia Debbie|RD|', 'Kuo|Paul C|PC|', 'Janjua|Haroon|H|', 'Abood|Gerard|G|', 'Baker|Marshall S|MS|']
D003363:Cost Control D003362:Cost-Benefit Analysis D016208:Databases, Factual D017558:Elective Surgical Procedures D005260:Female D005431:Florida D017048:Health Care Costs D006402:Hematologic Diseases D006498:Hepatectomy D061847:Hospitals, High-Volume D006801:Humans D010535:Laparoscopy D008099:Liver D008107:Liver Diseases D008297:Male D008396:Maryland D008875:Middle Aged D009518:New York D009657:North Carolina D016017:Odds Ratio D011183:Postoperative Complications D012120:Respiration Disorders D012189:Retrospective Studies D014861:Washington
Hepatectomy Cost-volume Healthcare economics Laparoscopic surgery