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Cost-Effective Surgical Management of Liver Disease Amidst a Financial Crisis

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Abstract

Background

Intraoperative use of specialized equipment and disposables contributes to the increasing cost of modern liver surgery. As a response to the recent severe financial crisis in our country we have employed a highly standardized protocol of liver resection that minimizes intraoperative and postoperative costs. Our goal is to evaluate cost-effectiveness of this protocol.

Study design

We evaluated retrospectively all patients who underwent open hepatic resections for 4 years. All resections were performed by the same surgical team under selective hepatic vascular exclusion, i.e., occlusion of the hepatoduodenal ligament and the major hepatic veins, occasionally combined with extrahepatic ligation of the ipsilateral portal vein. Sharp parenchymal transection was performed with a scalpel and hemostasis was achieved with sutures without the use of energy devices. In each case we performed a detailed analysis of costs and surgical outcomes.

Results

Our cohort included 146 patients (median age 63 years). 113 patients were operated for primary or metastatic malignancies and 33 for benign lesions. Operating time was 121 ± 21 min (mean ± SD), estimated blood loss was 310 ± 159 ml (mean ± SD), and hospital stay was 7 ± 5 days (mean ± SD). Six patients required admission in the ICU postoperatively. 90-day mortality was 2.74 %, and 8.9 % of patients developed grade III/IV postoperative complications (Clavien–Dindo classification). Total in-hospital cost excluding physician fees was 6987.63 ± 3838.51 USD (mean ± SD).

Conclusions

Our analysis suggests that, under pressing economic conditions, the proposed surgical protocol can significantly lessen the financial burden of liver surgery without compromising patient outcomes.

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Authors and Affiliations

  1. 4th Surgical Clinic, Attikon University Hospital, 1, Rimini Str., 12462, Athens, Greece

    Nikolaos Arkadopoulos, Georgios Gemenetzis, Nikolaos Danias, Panagiotis Kokoropoulos, Christos Bartsokas & Vassilios Smyrniotis

  2. 2nd Anesthesiology Clinic, Attikon University Hospital, Athens, Greece

    Ioanna Koukopoulou & Georgia Kostopanagiotou

Authors
  1. Nikolaos Arkadopoulos
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  2. Georgios Gemenetzis
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  3. Nikolaos Danias
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  4. Panagiotis Kokoropoulos
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  5. Ioanna Koukopoulou
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  6. Christos Bartsokas
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  7. Georgia Kostopanagiotou
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  8. Vassilios Smyrniotis
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Corresponding author

Correspondence to Georgios Gemenetzis.

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All authors declare no conflicts of interest.

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Arkadopoulos, N., Gemenetzis, G., Danias, N. et al. Cost-Effective Surgical Management of Liver Disease Amidst a Financial Crisis. World J Surg 40, 1695–1701 (2016). https://doi.org/10.1007/s00268-016-3440-2

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  • DOI: https://doi.org/10.1007/s00268-016-3440-2

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