Abhijit Shaligram, MBBS, Anton Simorov, MD, Vishal Kothari, MD, Matthew Goede, MD, Dmitry Oleynikov, MD. University of Nebraska Medical Center
Background: Patients with cirrhosis of the liver have been shown to carry significant risk of adverse outcome after common abdominal surgical procedures. With recent advances, laparoscopy is being increasingly utilized in management of these patients who need surgical intervention. This study aims to examine the safety and efficacy of common laparoscopic procedures in patients with cirrhosis of the liver and compare them with open procedures.
Method: This study is a multi-center, retrospective analysis utilizing a large administrative database. The University HealthSystem (UHC) Consortium is an alliance of over 200 academic medical centers and affiliate hospitals. The UHC database was accessed for all adult patients (>18 years old) discharged between October 2007 and September 2011 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD 9th CM) codes for cirrhosis of liver, cholecystectomy, appendectomy, groin, umbilical and incisional hernia repairs. The data on the following surgical outcome variables was obtained and analyzed: mortality, overall morbidity, hospital Length of stay (LOS), Intensive Care Unit (ICU) admission rate, 30-day readmission rate and hospital costs.
Results: A total of 3131 patients with cirrhosis underwent abdominal and groin hernia repair between October 2007 and September 2011. 1678 patients underwent open repair and 1453 were treated by laparoscopic technique. Both the groups were comparable in regards to their demographics, comorbidities and admission severity of illness. Compared to open procedure, laparoscopic procedures showed lower mortality (1.72% vs. 4.05%, p=0.0001), morbidity (7.63% vs. 11.9%, p=0.0001), hospital LOS (days) (5.88 ± 6.38 vs. 7.44 ± 8.87, p=0.0001), ICU admission rate (15.75% vs. 27.19%, p<0.0001), 30 day readmission rate (4.64% vs. 7.09%, p=0.0083) and significantly lower hospital costs ($)(11987± 21054 vs. 15407± 12446, p=0.0001).
Conclusion: Laparoscopy is safe and feasible in patients with cirrhosis of the liver who require common abdominal surgery. Overall laparoscopic procedures had better outcomes than open procedures resulting in significantly lower hospital costs. When feasible, a laparoscopic approach should be the standard of care in patients with cirrhosis.
Session Number: Poster – Poster Presentations
Program Number: P305