Short-Term Outcomes of Ablation Therapy for Hepatic Tumors: Evidence from the 2006–2009 Nationwide Inpatient Sample
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- Fox, J.P., Gustafson, J., Desai, M.M. et al. Ann Surg Oncol (2012) 19: 3677. doi:10.1245/s10434-012-2397-0
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Radiofrequency ablation (RFA) for the treatment of hepatic tumors has been increasingly used across the United States. Whether treatment-related morbidity has remained low with broader adoption is unclear. We conducted this study to describe in-hospital morbidity associated with RFA for hepatic tumors and to identify predictors of adverse events in a nationally representative database.
Using the 2006–2009 Nationwide Inpatient Sample, we evaluated all patients aged ≥40 years who underwent an elective RFA for primary or metastatic liver tumors (N = 1298). Outcomes included in-hospital procedure-specific and postoperative complications. Multivariable logistic regression analyses were performed to identify patient and facility predictors of complications.
Most patients underwent a percutaneous (39.9 %) or laparoscopic (22.0 %) procedure for metastatic liver tumors (57.5 %). Procedure-specific complications were frequent (18.2 %), with transfusion requirements (10.7 %), intraoperative bleeding (4.3 %), and hepatic failure (2.8 %) being the most common. Arrhythmias [adjusted odds ratio (AOR) = 1.93 (1.23–3.04)], coagulopathy [AOR = 4.65 (2.95–7.34)], and an open surgical approach [AOR = 2.77 (1.75–4.36)] were associated with an increased likelihood of procedure-specific complications, whereas hospital RFA volume ≥16/year was associated with a reduced likelihood [AOR = 0.59 (0.38–0.91)]. Postoperative complications were also common (12.0 %), with arrhythmias, heart failure, coagulopathy, and open surgical approach acting as significant predictors.
In-hospital morbidity is common after RFA for hepatic tumors. While several patient factors are associated with more frequent procedure-specific complications, treatment at hospitals with an annual volume ≥16 cases/year was associated with a 41 % reduction in the odds of procedure-specific complications.