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

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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.


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).


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.

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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.

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Correspondence to M. Stockmann.

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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).

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