Skip to main content
Log in

The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection—a single-center experience

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Postoperative liver failure (PLF) is a relatively frequent and life-threatening complication after extended liver resection. This study describes the economic burden of PLF from the hospitals' perspective and explores the role of liver function capacity.

Materials and methods

Economic data of total costs and cost distribution were analyzed for 48 patients who had participated in a prospective study with the LiMAx test, a novel test for liver function capacity. For this population, detailed individual data were available. The economic data were analyzed and adjusted for relevant covariates. In addition, economic data of 916 patients who had undergone liver resection during 2005–2007 were retrieved from the hospitals' medical controlling office for comparison.

Results

A significant difference between the costs of patients with regular recovery (25,980 Euro [95% confidence interval (95%CI) = 9,559 to 42,401]) versus patients developing PLF (82,199 Euro [95%CI = 42,812 to 121,586]; p = 0.013) was observed. The mean additional costs of PLF were 56,219 Euro. An equivalent cost difference of mortality was obtained from the analysis of 916 patients. Patients developing PLF had a decreased LiMAx of 61 µg/kg/h compared to the regular group 122 µg/kg/h (p < 0.001) after surgery. Initial postoperative LiMAx and total costs revealed a linear correlation coefficient of r = −0.340 (p = 0.018).

Conclusions

PLF is a very relevant medical and economic problem. Liver function capacity does not only predict PLF but also correlates with total costs in general.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bosch FX, Ribes J, Diaz M, Cleries R (2004) Primary liver cancer: worldwide incidence and trends. Gastroenterology 127:S5–S16

    Article  PubMed  Google Scholar 

  2. Williams R (2006) Global challenges in liver disease. Hepatology 44:521–526

    Article  PubMed  Google Scholar 

  3. Clavien PA, Petrowsky H, DeOliveira ML, Graf R (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356:1545–1559

    Article  PubMed  Google Scholar 

  4. Iwatsuki S, Todo S, Marsh JW, Madariaga JR, Lee RG et al (1998) Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J Am Coll Surg 187:358–364

    Article  CAS  PubMed  Google Scholar 

  5. Bismuth H, Adam R, Levi F, Farabos C, Waechter F et al (1996) Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 224:509–520 discussion 520–522

    Article  CAS  PubMed  Google Scholar 

  6. Lang BH, Poon RT, Fan ST, Wong J (2003) Perioperative and long-term outcome of major hepatic resection for small solitary hepatocellular carcinoma in patients with cirrhosis. Arch Surg 138:1207–1213

    Article  PubMed  Google Scholar 

  7. Miyazaki M, Kimura F, Shimizu H, Yoshidome H, Ohtsuka M et al (2007) Surgical treatment for liver cancer. Current issues. Dig Surg 24:120–125

    Article  PubMed  Google Scholar 

  8. Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K et al (1998) Aggressive surgical treatment of hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 5:52–61

    Article  CAS  PubMed  Google Scholar 

  9. Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J et al (2006) Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244:254–259

    Article  PubMed  Google Scholar 

  10. Baer HU, Stain SC, Dennison AR, Eggers B, Blumgart LH (1993) Improvements in survival by aggressive resections of hilar cholangiocarcinoma. Ann Surg 217:20–27

    Article  CAS  PubMed  Google Scholar 

  11. Truant S, Oberlin O, Sergent G, Lebuffe G, Gambiez L et al (2007) Remnant liver volume to body weight ratio > or =0.5%: a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 204:22–33

    Article  PubMed  Google Scholar 

  12. Yigitler C, Farges O, Kianmanesh R, Regimbeau JM, Abdalla EK et al (2003) The small remnant liver after major liver resection: how common and how relevant? Liver Transpl 9:S18–S25

    Article  PubMed  Google Scholar 

  13. Tucker ON, Heaton N (2005) The ‘small for size’ liver syndrome. Curr Opin Crit Care 11:150–155

    Article  CAS  PubMed  Google Scholar 

  14. van den Broek MA, Olde Damink SW, Dejong CH, Lang H, Malago M et al (2008) Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int 28:767–780

    Article  PubMed  CAS  Google Scholar 

  15. Schneider PD (2004) Preoperative assessment of liver function. Surg Clin North Am 84:355–373

    Article  PubMed  Google Scholar 

  16. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708 discussion 708–710

    PubMed  Google Scholar 

  17. Asiyanbola B, Chang D, Gleisner AL, Nathan H, Choti MA et al (2008) Operative mortality after hepatic resection: are literature-based rates broadly applicable? J Gastrointest Surg 12:842–851

    Article  PubMed  Google Scholar 

  18. Stockmann M, Lock JF, Riecke B, Heyne C, Martus P et al (2009) Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg. doi: 10.1097/SLA.0b013e3181ad85b5

  19. InEK (2007) Handbuch zur Kalkulation von Fallkosten. Deutsche Krankenhaus Verlagsgesellschaft mbH

  20. InEK (2008) G-DRG HA V2006/2008 Report-Browser

  21. Zimmermann H, Reichen J (1998) Hepatectomy: preoperative analysis of hepatic function and postoperative liver failure. Dig Surg 15:1–11

    Article  CAS  PubMed  Google Scholar 

  22. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A et al (2005) The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 discussion 828–829

    Article  PubMed  Google Scholar 

  23. Asanuma Y, Sato T, Yasui O, Kurokawa T, Koyama K (2003) Treatment for postoperative liver failure after major hepatectomy under hepatic total vascular exclusion. J Artif Organs 6:152–156

    PubMed  Google Scholar 

  24. Tsao JI, Asbun HJ, Hughes KS, Abaubara S, August DA et al (1994) Hepatoma registry of the Western world. Repeat Hepatic Resection Registry. Cancer Treat Res 69:21–31

    CAS  PubMed  Google Scholar 

  25. Nonami T, Nakao A, Kurokawa T, Inagaki H, Matsushita Y et al (1999) Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure. Hepatogastroenterology 46:1669–1672

    CAS  PubMed  Google Scholar 

  26. Rea DJ, Munoz-Juarez M, Farnell MB, Donohue JH, Que FG et al (2004) Major hepatic resection for hilar cholangiocarcinoma: analysis of 46 patients. Arch Surg 139:514–523 discussion 523–525

    Article  PubMed  Google Scholar 

  27. Neuhaus P, Jonas S, Settmacher U, Thelen A, Benckert C et al (2003) Surgical management of proximal bile duct cancer: extended right lobe resection increases resectability and radicality. Langenbecks Arch Surg 388:194–200

    Article  PubMed  Google Scholar 

  28. Dinant S, Gerhards MF, Rauws EA, Busch OR, Gouma DJ et al (2006) Improved outcome of resection of hilar cholangiocarcinoma (Klatskin tumor). Ann Surg Oncol 13:872–880

    Article  PubMed  Google Scholar 

  29. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D et al (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204:854–862 discussion 862–864

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Charité Medical Controlling and Strategy Office for the provision of the economic data, especially Mr. Andy Bloch for his active personal support of this analysis. We thank S. Niehues for performing the CT volumetry. In addition, we thank Professor P. Martus, Chair of the Institute for Biostatistics and Clinical Epidemiology of Charité for the assistance with statistical analyses.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Stockmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lock, J.F., Reinhold, T., Malinowski, M. et al. The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection—a single-center experience. Langenbecks Arch Surg 394, 1047–1056 (2009). https://doi.org/10.1007/s00423-009-0518-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-009-0518-4

Keywords

Navigation