Abstract
The safety of hepatectomy continues to improve and it holds a key role in the management of benign and malignant hepatic lesions. Laparoscopic and robotic approaches to hepatectomy are increasingly utilized. The purpose of this study was to compare outcomes and costs of laparoscopic and robotic vs. open approaches to hepatectomy and to determine the national nonelective postoperative readmission rate, including readmission to other hospitals. The Nationwide Readmission Database from 2013 to 2014 was queried for all patients undergoing hepatectomy. Patients undergoing laparoscopic and robotic hepatectomies were compared to patients undergoing open hepatectomy. Multivariate logistic regression was implemented to determine the odds ratios (OR) for non-elective readmission within 45 days. There were 10,870 patients who underwent hepatectomy from 2013 to 2014 and 724 (6.7%) were approached with laparoscopic or robotic technique. The robotic cohort had lower mean cost of the index admission ($24,983 ± $18,329 vs. open $32,391 ± $31,983, p < 0.001, 95% CI − 18,292 to 534), shorter LOS (4.5 ± 3.8 vs. lap 6.8 ± 6.0 vs. open 7.6 ± 7.7 days, p < 0.01), and were less likely to be readmitted within 45 days (7.9% vs. 13.0% lap vs. 13.8% open, p = 0.05). The robotic cohort was slightly younger (mean age 57.5 ± 13.5 vs. lap 60.1 ± 13.8 vs. open 58.9 ± 13.7, p < 0.05), and no significant differences were seen by Charlson Comorbidity Index. Anastomosis of hepatic duct to GI tract carried higher odds of mortality (OR 2.87, p < 0.01) and higher odds of readmission (OR 1.40, p < 0.01). LOS above 7 days increased odds of readmission (OR 2.24, p < 0.01). Nearly one-fifth of patients readmitted after hepatectomy present to a different hospital. Robotic hepatectomy was associated with favorable cost and readmission outcomes compared to laparoscopic and open hepatectomy patients, despite similar patient comorbid burdens and patient’s age. Length of stay over 7 days and anastomosis of hepatic duct to GI tract are strong risk factors for readmission and mortality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Dimick JB, Wainess RM, Cowan JA, Upchurch GR Jr, Knol JA, Colletti LM (2004) National trends in the use and outcomes of hepatic resection. J Am Coll Surg 199(1):31–38
Ejaz A et al (2014) A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the Nationwide Inpatient Sample. Surgery 156:538–547
Luo L, Zou H, Yao Y, Huang X (2015) Laparoscopic versus open hepatectomy for hepatocellular carcinoma: short- and long-term outcomes comparison. Int J Clin Exp Med 8:18772–18778
Franken C, Lau B, Putchakayala K, DiFronzo LA (2014) Comparison of short-term outcomes in laparoscopic vs open hepatectomy. JAMA Surg 149:941–946
Thornblade LW, Shi X, Ruiz A, Flum DR, Park JO (2017) Comparative effectiveness of minimally invasive surgery and conventional approaches for major or challenging hepatectomy. J Am Coll Surg 224:851–861
Bagante F et al (2016) Minimally invasive vs. open hepatectomy: a comparative analysis of the national surgical quality improvement program database. J Gastrointest Surg 20:1608–1617
Spolverato G et al (2014) Readmission incidence and associated factors after a hepatic resection at a major hepato-pancreatico-biliary academic centre. HPB 16:972–978
Schneider EB et al (2012) Patient readmission and mortality after surgery for hepato-pancreato-biliary malignancies. J Am Coll Surg 215:607–615
Lucas DJ, Sweeney JF, Pawlik TM (2014) The timing of complications impacts risk of readmission after hepatopancreatobiliary surgery. Surgery 155:945–953
Barbas AS et al (2013) Examining reoperation and readmission after hepatic surgery. J Am Coll Surg 216:915–923
Kelly KN, Iannuzzi JC, Rickles AS, Monson JRT, Fleming FJ (2014) Risk factors associated with 30-day postoperative readmissions in major gastrointestinal resections. J Gastrointest Surg 18:35–43 (discussion 43–44)
Kassin MT et al (2012) Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg 215:322–330
Jweinat JJ (2010) Hospital readmissions under the spotlight. J Healthc Manag 55:252–264
Centers for Medicare and Medicaid Services. Readmission reduction program (2012) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Modified April 18th, 2016. Accessed 1 May 2017
Scally CP, Thumma JR, Birkmeyer JD, Dimick JB (2015) Impact of surgical quality improvement on payments in medicare patients. Ann Surg 262:249–252
Brudvik KW et al (2015) Definition of readmission in 3041 patients undergoing hepatectomy. J Am Coll Surg 221:38–46
Introduction to the HCUP Nationwide Readmissions Database (NRD) (2016). https://www.hcup-us.ahrq.gov/db/nation/nrd/NRD_ Introduction_2013.jsp. Accessed 28 Dec 2016
Ono Y et al (2017) Short-term outcomes after simultaneous colorectal and major hepatic resection for synchronous colorectal liver metastases. Dig Surg. https://doi.org/10.1159/000455295
Alexandrescu S et al (2017) Comparative analysis between simultaneous resection and staged resection for synchronous colorectal liver metastases—a single center experience on 300 consecutive patients. Chirurgia 112:278–288
Abelson JS et al (2017) Simultaneous resection for synchronous colorectal liver metastasis: the new standard of care? J Gastrointest Surg 21:975–982
Daskalaki D et al (2017) Financial impact of the robotic approach in liver surgery: a comparative study of clinical outcomes and costs between the robotic and open technique in a single institution. J Laparoendosc Adv Surg Tech A 27:375–382
Sham JG et al (2016) Efficacy and cost of robotic hepatectomy: is the robot cost-prohibitive? J Robot Surg 10:307–313
Salloum C et al (2017) Robotic-assisted versus laparoscopic left lateral sectionectomy: analysis of surgical outcomes and costs by a propensity score matched cohort study. World J Surg 41:516–524
Croner RS, Perrakis A, Hohenberger W, Brunner M (2016) Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg 401:707–714
Yu Y-D et al (2014) Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg 399:1039–1045
Chen P-D et al (2017) Robotic major hepatectomy: is there a learning curve? Surgery 161:642–649
Levi Sandri GB et al (2017) The use of robotic surgery in abdominal organ transplantation: a literature review. Clin Transpl 2017:31
Chen P-D et al (2016) Robotic liver donor right hepatectomy: a pure, minimally invasive approach. Liver Transpl 22:1509–1518
Nota CLMA, Molenaar IQ, van Hillegersberg R, Borel Rinkes IHM, Hagendoorn J (2016) Robotic liver resection including the posterosuperior segments: initial experience. J Surg Res 206:133–138
Magistri P, Tarantino G, Ballarin R, Coratti A, Di Benedetto F (2017) Robotic liver donor right hepatectomy: a pure, minimally invasive approach. Liver Transpl 23:857–858
Montalti R, Scuderi V, Patriti A, Vivarelli M, Troisi R (2016) I. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc 30:1004–1013
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Drs. Nicholas Cortolillo, Chetan Patel, Joshua Parreco, Srinivas Kaza, and Alvaro Castillo have no conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Cortolillo, N., Patel, C., Parreco, J. et al. Nationwide outcomes and costs of laparoscopic and robotic vs. open hepatectomy. J Robotic Surg 13, 557–565 (2019). https://doi.org/10.1007/s11701-018-0896-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-018-0896-0