Comparison of clinical and economic outcomes between minimally invasive liver resection and open liver resection: a propensity-score matched analysis.

ABSTRACT

BACKGROUND: Minimally invasive liver resection (MILR) has gained momentum in recent years. This study of contemporary data compares economic and clinical outcomes between MILR and open liver resection (OLR). METHODS: We extracted data for patients undergoing liver resection between October 2015-September 2018 from the Premier Healthcare Database. We conducted a propensity score matched analysis to compare complications, in-hospital mortality, inpatient readmissions, discharge to institutional post-acute care, operating room time (ORT), length of stay (LOS), and total hospital cost between MILR and OLR patients. RESULTS: From the eligible OLR (n = 3349) and MILR (n = 1367) patients, we propensity score matched 1261 from each cohort at a 11 ratio. After matching, MILR was associated with lower rates of complications (bleeding 8.2% vs. 17.4%; respiratory failure 5.5% vs. 10.9%; intestinal obstruction 3.6% vs. 6.0%, and pleural effusion 1.9% vs. 4.9%), in-hospital mortality (0.5% vs. 3.0%), 90-day inpatient readmissions (10.4% vs. 14.3%), discharge to institutional post-acute care (6.9% vs. 12.3%), shorter ORT (257 vs. 308 min) and LOS (4.3 vs. 7.2 days), and lower hospital costs ($19463 vs. $29119) (all P < 0.001). CONCLUSION: MILR was associated with lower risk of complications and reduced hospital resource utilizations as compared with OLR.