Introduction: Laparoscopic liver resection (LLR) for benign and malignant liver tumors has become a popular modality over the last decade in many centers. The reports from the high volume centers suggest that LLR has shorter hospital stay, lower hospital charge and lower complication rate compared to open charge. We wanted to validate the safety, in-hospital outcomes and cost of LLR as compared to open liver resection (OLR) by using a national database.
Methods: Retrospective analysis of the Nationwide Inpatient Sample (representative 20% sample from 37 states) (2000 through 2006). Patients with diagnosis of benign and malignant primary liver tumors were included and then divided into two groups: OLR and LLR. Outcomes measured were related to in-hospital stay which included length of stay, complication, in-hospital death, and hospital charges.
Results: A total of 2,509 patients were identified for both cohorts with 73 patients (2.9%) in LLR group. Both groups were comparable (p>0.05) in their demographics in regards to mean age, race, gender and Charlson’s morbidity score. Both groups received care in large urban teaching centers (89% LLR vs. 84% OLR, p=0.65). LLR had no complications compared to 4.8% in OLR group (p=0.05). No significant difference was seen in length of stay, in-hospital death and average hospitalization charge between the two groups. On multivariate analysis, the variables to predict in-hospital death by adjusted odds ratio were type of insurance (HMO reference) (Medicare OR 1.95, 95% CI 0.97-3.91) (Medicaid OR 2.97, 95% CI 1.26-7.0), age (OR 1.04, 95% CI 1.01-1.06), Charlson’s score (OR 1.14, 95% CI 1.03-1.25), hospital cost (OR 2.1, 95% CI 1.74-2.53) and male gender (OR 0.53, 95% CI 0.31-0.9). Type of resection (p=0.3), laparoscopic vs. open, and complications (p=0.1) were not significant.
Conclusion: Patients with benign and malignant liver tumors have similar safety outcome measures regardless of laparoscopic or open liver resection. Both groups, LLR and OLR, had no difference in the length of stay or hospital charge. The choice of operation should be based on surgeon’s preference taking into account the experience, tumor biology and best oncologic outcome
Program Number: P412