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Laparoscopic vs open right hepatectomy: a value-based analysis.

Publication ,  Journal Article
Medbery, RL; Chadid, TS; Sweeney, JF; Knechtle, SJ; Kooby, DA; Maithel, SK; Lin, E; Sarmiento, JM
Published in: J Am Coll Surg
May 2014

BACKGROUND: Current literature lacks sufficient data on outcomes after extensive laparoscopic liver resections. We hypothesized that laparoscopic right hepatectomy (LRH) is associated with better clinical outcomes and less overall hospital costs than open right hepatectomy (ORH), supporting the notion that major laparoscopic hepatic resections carry increased value when compared with the open approach. STUDY DESIGN: We reviewed medical records of all patients at our institution who underwent elective LRH (n = 48) or ORH (n = 57) from May 16, 2008 to March 1, 2012. Patient demographics, preoperative comorbidities, operative details, and postoperative outcomes were compared between the 2 groups. Hospital billing data were collected for each case to determine the average hospital costs per case. RESULTS: Average operative duration, estimated blood loss, intravenous fluid resuscitation requirements, high-grade postoperative complications, the need for postoperative admission to the ICU, and hospital length of stay were significantly less within the LRH cohort. Thirty-day mortality and readmission rates were equivalent between the 2 groups. Despite higher operative costs for LRH ($16,605 vs $10,411, p < 0.001), total postoperative costs were significantly less ($9,075 for LRH vs $16,341 for ORH, p < 0.001), resulting in equivalent overall costs ($25,679 for LRH vs $26,751 for ORH, p = 0.65). CONCLUSIONS: Although overall costs between LRH and ORH are equivalent, clinical outcomes after LRH are comparable to those after ORH, supporting the value of laparoscopy in extensive right hepatic resections. Efforts to reduce operative costs of LRH, while maintaining optimal patient outcomes, should be the focus of surgeons and hospitals moving forward.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

May 2014

Volume

218

Issue

5

Start / End Page

929 / 939

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Liver Diseases
  • Length of Stay
  • Laparoscopy
  • Humans
  • Hospital Costs
  • Hepatectomy
 

Citation

APA
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MLA
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Medbery, R. L., Chadid, T. S., Sweeney, J. F., Knechtle, S. J., Kooby, D. A., Maithel, S. K., … Sarmiento, J. M. (2014). Laparoscopic vs open right hepatectomy: a value-based analysis. J Am Coll Surg, 218(5), 929–939. https://doi.org/10.1016/j.jamcollsurg.2014.01.045
Medbery, Rachel L., Tatiana S. Chadid, John F. Sweeney, Stuart J. Knechtle, David A. Kooby, Shishir K. Maithel, Edward Lin, and Juan M. Sarmiento. “Laparoscopic vs open right hepatectomy: a value-based analysis.J Am Coll Surg 218, no. 5 (May 2014): 929–39. https://doi.org/10.1016/j.jamcollsurg.2014.01.045.
Medbery RL, Chadid TS, Sweeney JF, Knechtle SJ, Kooby DA, Maithel SK, et al. Laparoscopic vs open right hepatectomy: a value-based analysis. J Am Coll Surg. 2014 May;218(5):929–39.
Medbery, Rachel L., et al. “Laparoscopic vs open right hepatectomy: a value-based analysis.J Am Coll Surg, vol. 218, no. 5, May 2014, pp. 929–39. Pubmed, doi:10.1016/j.jamcollsurg.2014.01.045.
Medbery RL, Chadid TS, Sweeney JF, Knechtle SJ, Kooby DA, Maithel SK, Lin E, Sarmiento JM. Laparoscopic vs open right hepatectomy: a value-based analysis. J Am Coll Surg. 2014 May;218(5):929–939.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

May 2014

Volume

218

Issue

5

Start / End Page

929 / 939

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Liver Diseases
  • Length of Stay
  • Laparoscopy
  • Humans
  • Hospital Costs
  • Hepatectomy