Extent of hepatic resection impacts expense of care at no extra physiologic cost

Abstract

Purpose: We sought to publish the differences in perioperative outcomes and costs in patients undergoing major and minor hepatectomy for liver tumors at a tertiary hepatobiliary center. Method: Patients undergoing hepatectomy were classified as major (≥3 segments) and minor (<3 segment) resections. Perioperative, cost and charge variables were tabulated. Statistically significant differences, defined as p<0.05, were determined by Student’s t-test. Results: 217 and 153 patients underwent major and minor hepatectomy respectively. There were no differences in age, gender, BMI or ASA score between the two groups. Estimated blood loss (p=0.0008), operative time (p=0.0001) and lesion size (p=0.0001) were significantly greater in patients with major hepatectomy vs minor hepatectomy. Length of stay (p=1.00), in hospital mortality (p=0.2) and 30 day mortality (p=0.54) were not significantly different between the two groups. Intraoperative (p=0.001), variable (p=0.002) and total costs (p=0.01) were significantly greater for patients undergoing major hepatectomy, but not postoperative (p=0.49), fixed (p=0.18) nor fixed indirect costs (p=0.09). Total hospital charges were significantly greater in patients undergoing major hepatectomy (p=0.001), but payments received was not (p=0.38). Conclusion: Major hepatectomy resulted in greater operative time, blood loss and total costs, surrogates of a technically more challenging resection than minor hepatectomy. Major hepatectomy led to greater hospital charges but not payments received. Mortality and length of stay are equivalent between major and minor hepatectomy.Tabled 1VID067MajorMinorTotal| p-ValuePatients (n)217153370EBL (mL)200(319±368.4)100(196±308.4)p=0.0008*Operative Time (minutes)289(300±116.6)216(240±121.7)p=0.0001*Size of Lesion (cm)5(6±3.9)3(4±3.3)p=0.0001*Length of Stay (days)4(5±3.9)3(5±5.1)p=1.0030 Day Mortality8 (4%)3 (2%)p=0.54Total Hospital Charges$187,286($201,749 ± $125,487.0)$144,944($162,294 ± $94,436.4)p=0.001*Total Cost$30,622($34,710 ± $29,055.5)$24,588($27,855 ± $17,673.7)p=0.01*Payments Received$19,508($42,993 ± $44,704.0)$18,037($38,620 ± $44,296.4)p=0.38 Open table in a new tab