Advertisement

Langenbeck's Archives of Surgery

, Volume 404, Issue 4, pp 469–475 | Cite as

Laparoscopic versus open hemihepatectomy—a cost analysis after propensity score matching

  • S. Wabitsch
  • A. Kästner
  • P. K. Haber
  • L. Feldbrügge
  • T. Winklmann
  • S. Werner
  • J. Pratschke
  • Moritz SchmelzleEmail author
Original Article
  • 118 Downloads

Abstract

Introduction

Cost efficiency is important for hospitals in order to provide high-quality health care for all patients. As hemihepatectomies are increasingly being performed laparoscopically, the aims of this study were to evaluate the costs of laparoscopic hemihepatectomy and to compare them to conventional open techniques.

Patients and methods

This is a retrospective analysis of clinical outcomes and financial calculations of all patients who underwent hemihepatectomy between January 2015 and December 2016 at the Department of Surgery, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Berlin, Germany, being allocated to the DRG (diagnosis-related group) H01A (complex operations of the liver and pancreas with complex intensive care treatment) or H01B (operations of the liver and pancreas without complex intensive care treatment). To overcome selection bias, a 1:1 propensity score matching (PSM) analysis was performed.

Results

After PSM, a total of 64 patients were identified; 32 patients underwent laparoscopic hemihepatectomy (LH); and 32 patients received open hemihepatectomy (OH). After PSM, no significant differences were observed in clinical baseline characteristics. The duration of surgery was significantly longer for patients undergoing LH compared to OH (LH, 334 min, 186–655 min; OH, 274 min, 176–454 min; p = 0.005). Patients in the LH group had a significantly shortened median hospital stay of 5 d, when compared to OH (LH, 9.5 d, 3–35 d; OH, 14.5 d, 7–37d; p = 0.005). We observed a significant higher rate of postoperative complication in the OH group (p = 0.022). Cost analysis showed median overall costs of 17,369.85€ in the LH group and 16,103.64€ in the OH group (p = 0.390).

Conclusion

Our data suggest that higher intraoperative costs of laparoscopic liver surgery, e.g., for surgical devices and due to longer operation times, are compensated by fewer postoperative complications and consecutive shorter length of stay when compared with OH.

Keywords

Hemihepatectomy Laparoscopy Cost analysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval (application no. EA2/006/16) was obtained before analysis of the data. Approval from the local ethics committee includes the usage and publication of those retrospectively analyzed data. Due to the blinded data and retrospective design, written informed consent was not considered necessary by the ethics committee.

References

  1. 1.
    Lacy AM, García-Valdecasas JC, Piqué JM, Delgado S, Campo E, Bordas JM et al (1995) Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9(10):1101–1105CrossRefPubMedGoogle Scholar
  2. 2.
    Schwenk W, Böhm B, Müller JM (1998) Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial. Surg Endosc 12(9):1131–1136CrossRefPubMedGoogle Scholar
  3. 3.
    Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, Hirokawa F, Taniai N, Watanabe M, Katou M, Nagano H, Honda G, Baba H, Kokudo N, Konishi M, Hirata K, Yamamoto M, Uchiyama K, Uchida E, Kusachi S, Kubota K, Mori M, Takahashi K, Kikuchi K, Miyata H, Takahara T, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22(10):711–720CrossRefPubMedGoogle Scholar
  4. 4.
    Parks KR, Kuo Y-H, Davis JM, O’ Brien B, Hagopian EJ (2014) Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB (Oxford) 16(2):109–118CrossRefGoogle Scholar
  5. 5.
    Okuno M, Goumard C, Mizuno T, Omichi K, Tzeng CD, Chun YS et al (2017) Operative and short-term oncologic outcomes of laparoscopic versus open liver resection for colorectal liver metastases located in the posterosuperior liver: a propensity score matching analysis. Surg Endosc [zitiert 16. Januar 2018]; Verfügbar unter: http://europepmc.org/abstract/med/28917012
  6. 6.
    Ahn KS, Kang KJ, Kim YH, Kim T-S, Lim TJ (2014) A propensity score-matched case-control comparative study of laparoscopic and open liver resection for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 24(12):872–877CrossRefPubMedGoogle Scholar
  7. 7.
    Aikawa M, Miyazawa M, Okamoto K, Toshimitsu Y, Okada K, Ueno Y, Yamaguchi S, Koyama I (2012) Single-port laparoscopic hepatectomy: technique, safety, and feasibility in a clinical case series. Surg Endosc 26(6):1696–1701CrossRefPubMedGoogle Scholar
  8. 8.
    Sotiropoulos GC, Prodromidou A, Machairas N (2017) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma: the European experience. J BUON 22(5):1160–1171PubMedGoogle Scholar
  9. 9.
    Vanounou T, Steel JL, Nguyen KT, Tsung A, Marsh JW, Geller DA, Gamblin TC (2010) Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol 17(4):998–1009CrossRefPubMedGoogle Scholar
  10. 10.
    Dokmak S, Raut V, Aussilhou B, Ftériche FS, Farges O, Sauvanet A, Belghiti J (2014) Laparoscopic left lateral resection is the gold standard for benign liver lesions: a case–control study. HPB (Oxford) 16(2):183–187CrossRefGoogle Scholar
  11. 11.
    Cipriani F, Ratti F, Cardella A, Catena M, Paganelli M, Aldrighetti L (2019) Laparoscopic versus open major hepatectomy: analysis of clinical outcomes and cost effectiveness in a high-volume center. J Gastrointest Surg.  https://doi.org/10.1007/s11605-019-04112-4
  12. 12.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMedGoogle Scholar
  13. 13.
    Abu Hilal M, Di Fabio F, Syed S, Wiltshire R, Dimovska E, Turner D et al (2013) Assessment of the financial implications for laparoscopic liver surgery: a single-centre UK cost analysis for minor and major hepatectomy. Surg Endosc 27(7):2542–2550CrossRefPubMedGoogle Scholar
  14. 14.
    Cannon RM, Scoggins CR, Callender GG, Quillo A, McMasters KM, Martin RCG (2013) Financial comparison of laparoscopic versus open hepatic resection using deviation-based cost modeling. Ann Surg Oncol 20(9):2887–2892CrossRefPubMedGoogle Scholar
  15. 15.
    Schemmer P, Bruns H, Weitz J, Schmidt J, Büchler MW (2008) Liver transection using vascular stapler: a review. HPB (Oxford) 10(4):249–252CrossRefGoogle Scholar
  16. 16.
    Rahbari NN, Elbers H, Koch M, Vogler P, Striebel F, Bruckner T, Mehrabi A, Schemmer P, Büchler MW, Weitz J (2014) Randomized clinical trial of stapler versus clamp-crushing transection in elective liver resection. Br J Surg 101(3):200–207CrossRefPubMedGoogle Scholar
  17. 17.
    Bhojani FD, Fox A, Pitzul K, Gallinger S, Wei A, Moulton C-A, Okrainec A, Cleary SP (2012) Clinical and economic comparison of laparoscopic to open liver resections using a 2-to-1 matched pair analysis: an institutional experience. J Am Coll Surg 214(2):184–195CrossRefPubMedGoogle Scholar
  18. 18.
    Stoot JHMB, van Dam RM, Coelen RJS, Winkens B, Olde Damink SWM, Bemelmans MHA et al (2012) The introduction of a laparoscopic liver surgery programme: a cost analysis of initial experience in a university hospital. Scand J Surg 101(1):32–37CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • S. Wabitsch
    • 1
  • A. Kästner
    • 1
  • P. K. Haber
    • 1
  • L. Feldbrügge
    • 1
  • T. Winklmann
    • 1
  • S. Werner
    • 1
  • J. Pratschke
    • 1
  • Moritz Schmelzle
    • 1
    Email author
  1. 1.Department of Surgery, Campus Charité Mitte and Campus Virchow-KlinikumCharité–Universitätsmedizin BerlinBerlinGermany

Personalised recommendations