SSAT - Minimally Invasive Hepatectomy: A Comparison of Safety, Cost, and Patient Experience to the Open Approach

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Minimally Invasive Hepatectomy: A Comparison of Safety, Cost, and Patient Experience to the Open Approach
Rebecca M. Dodson^*, Harveshp Mogal, Nora Fino, Clancy J. Clark, Perry Shen
Surgical Oncology, Wake Forest Baptist Health, Winston-Salem, NC

Background: Minimally invasive hepatectomy (MIH) techniques have shown decreased length of stay (LOS) and reduced pain at the expense of increased operating room time and cost compared to open hepatectomy (OH).
Objectives: The aim of the current study is to compare the impact of MIH vs OH on safety, cost and patient experience.
Methods: Retrospective single institution review of 584 consecutive patients who underwent hepatectomy from 1999 to 2015. Patient demographics, comorbidities, operative details, complications, operative cost, total hospital costs, and patient reported Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were collected and compared using standard statistical methods.
Results: 584 patients that underwent hepatectomy were analyzed. MIH (n=116) included 4 robotic, 14 laparoscopic, 77 hand assisted, and 8 hybrid resections, with 13 conversions to OH. There were no differences in age, sex, or BMI. MIH patients had more comorbidities (2.23 vs 1.65, p<0.0001) and benign pathology (15.6 vs 6.0, p=0.0009). Major resection was similar between MIH and OH using the revised major resection definition (40.5 vs 39.7, p=0.87).There were no differences in complications (44.9 vs 42.2, p=0.64), readmissions (8.16 vs 9.47, p=0.688) total hospital costs (,897 vs 23,713, p=0.10), total operative costs (,334 vs 10,547, p=0.0987), and HCAHPS scores (81.9 vs 82.2, p=0.64) in MIH vs OH, respectively. MIH did have higher supply costs (4,839 vs 4,172, p=0.0093), but lower operative time costs (,468 vs 3,947, p=0.0046), LOS (5.6 vs 8.7days, p=0.0011), and blood loss (493 vs 524 mL, p=0.016). Higher hospital costs on multivariate analysis were associated with operative time (p<0.001) and tumor size (p=0.0063).
Conclusion: Selection bias still exists in MIH vs OH with respect to clinicopathologic factors. This study demonstrates MIH can be performed safely and can offer similar economic outcomes and patient experiences in selected patients undergoing hepatectomy.

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