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Nationwide Outcomes and Costs of Laparoscopic and Robotic versus Open Hepatectomies

Chetan Patel, MD, Joshua Parreco, MD, Srinivas Kaza, MD, Alvaro Castillo, MD. University of Miami Palm Beach

INTRODUCTION: Previous studies have demonstrated a wide range of readmission rates after hepatectomy and have been limited to readmissions at a single institution and an inability to distinguish elective from nonelective readmissions. The purpose of this study was to determine the nationwide readmission rate after hepatectomy and to compare the outcomes of laparoscopic and robotic versus an open approach.

METHODS AND PROCEDURES: The Nationwide Readmission Database for 2013 was queried for all patients undergoing a hepatectomy. Patients undergoing laparoscopic and robotic hepatectomies were compared to patients undergoing open hepatectomy. The mean and standard deviation (SD) was calculated for continuous variables and compared using t-test for equality of means. Multivariate logistic regression was used to determine the odds ratios (OR) for the outcomes of interest.

RESULTS: There were 6,721 patients undergoing hepatectomies in 2013, and 402 (6.0%) were done with a laparoscopic or robotic approach. During the initial admission, 187 (2.8%) patients died. Of the survivors, 983 (15.0%) had nonelective readmissions within 45 days and 189 (19.2%) of these patients were readmitted to a different hospital. The laparoscopic and robotic patients had fewer comorbidities (2.2 +/1.6 versus 2.4 +/1.8, p<0.01, 95% CI 0.1 to 0.4) and a shorter length of stay (7.0 +/6.8 versus 8.9 +/10.5 days, p<0.01, 95% CI 0.9 to 3.0). They also had a lower mean weighted cost of the initial admission ($255,993.61 +/ $246,188.97 versus $310,952.16 +/ $392,244.23, p<0.01, 95% CI 15,626.49 to 94,290.62). The strongest predictors of death during the mean follow up period (32.8 +/60.8 days) were anastomosis of hepatic duct to gastrointestinal tract (OR 3.38, p<0.01, 95% CI 2.26 to 5.05) and age >=65 years (OR 2.47, p<0.01, 95% CI 1.72 to 3.56). The strongest predictors of readmission within 45 days were 3 or more comorbidities (OR 2.48, p<0.01, 95% CI 1.88 to 3.27) and anastomosis of hepatic duct to gastrointestinal tract (OR 2.33, p<0.01, 95% CI 1.72 to 3.15). Open versus laparoscopic and robotic was not a significant risk factor for death (OR 1.48, p=0.20, 95% CI 0.81 to 2.69) or readmission within 45 days (OR 1.11, p=0.50, 95% CI 0.82 to 1.50).

CONCLUSION(S): Many patients are readmitted to different hospitals after hepatectomy and this could lead to an underestimation of readmission rates. Patients undergoing laparoscopic or robotic versus open hepatectomy have similar rates of mortality and nonelective readmission.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 78802

Program Number: S081

Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session

Presentation Type: ResFel

39

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