The predictors of intra-operative surgical expenses in liver resection for hepatocellular carcinoma

Abstract

Abstract Background This study aimed to clarify the expenses associated with various items and predictors of intraoperative expenses in liver resection for hepatocellular carcinoma (HCC). Materials and Methods A total of 562 patients with HCC who underwent liver resection from January 2015 to December 2019 were enrolled in this retrospective study. The direct variables of total intraoperative expenses were the summation of surgeon’s fee, anesthetic fee, fees for pharmacy, and disposable supplies, which were analyzed based on surgeons’ seniority, patients’ demographic features and comorbidity, clinical features of HCC, and complexity of surgery and surgical approach. Results Of the total cost, 43.3% accounted for expenses of disposing supplies, 32.8% for surgeons’ fees, 15.9% for anesthetic fees, and 8.12% for pharmacy fees. A hierarchical model of multivariate regression analysis showed that the total expenses and that of disposable supplies were significantly higher in surgeons with seniority of over 26 years (p < 0.001) and those having a specialization of robotic surgery (p < 0.001). Further, the complexity and robotic approach of surgery predicted the total expenses (R2 = 0.862, p < 0.001). Robotic approach and its disposable supplies and major liver resection increased by 93.2% and 20.1% (p < 0.001) of total expenses when compared to open liver resection or partial liver resection, respectively. Conclusion The study found that the robotic approach, disposable supplies, and complexity of surgery were the most important predictors of total intraoperative expenses for patients with HCC. Therefore, a cost-effectiveness analysis should be conducted to define the surgical value of the robotic approach for HCC resection.