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

Wabitsch, Simon; Kästner, Anika; Haber, Philipp K.; Feldbrügge, Linda; Winklmann, Thomas; Werner, Sven; Pratschke, Johann; Schmelzle, Moritz

doi:10.1007/s00423-019-01790-1

Cited by 14 publications

(14 citation statements)

References 17 publications

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“…Therefore, low complication rates of laparoscopic liver surgery may be favorable for billing [88]. In our analysis, patients after laparoscopic hemihepatectomy were indeed characterized by a significantly lower rate of postoperative complications and a shortened median hospital stay of 5 days [81], resulting in comparable total costs after laparoscopic and open hemihepatectomy with 17,369.85€ and 16,103.64€, respectively. Cost-effectiveness was confirmed by the OSLO-COMET trial due to shorter stays on ICU and hospital stay and a lower readmission rate [21].…”

Section: Postoperative and Total Costsmentioning

confidence: 66%

“…In a retrospective analysis, our group compared costs in laparoscopic and open hemihepatectomy 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) [ 81 ]. After propensity score matching, intraoperative costs were significantly higher in laparoscopic compared with open hemihepatectomy with ~ 8000€ and ~ 4000€, respectively.…”

Section: Economic Aspectsmentioning

confidence: 99%

“…However, it should not be forgotten that the data generated so far have been collected within the framework of learning curves and an improvement in this respect is expected in the coming years at many centers [ 84 , 85 ]. Staplers are commonly used in laparoscopic liver surgery for transection of parenchyma and vessels; however, they are among the major cost drivers in laparoscopic surgery [ 81 , 86 , 87 ]. Therefore, econometric aspects should not be disregarded when selecting intraoperative strategies and favored techniques.…”

Section: Economic Aspectsmentioning

confidence: 99%

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Laparoscopic liver resection: indications, limitations, and economic aspects

Schmelzle

Krenzien

Schöning

et al. 2020

Langenbecks Arch Surg

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Background Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery. Purpose This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion. Conclusions While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement.

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Section: Postoperative and Total Costsmentioning

confidence: 66%

Section: Economic Aspectsmentioning

confidence: 99%

Section: Economic Aspectsmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic liver resection: indications, limitations, and economic aspects

Schmelzle

Krenzien

Schöning

et al. 2020

Langenbecks Arch Surg

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“…Medical complications not reaching the point of requiring invasive and/or intensive care treatment may have been under-detected and/or -reported in previous retrospective studies evaluating outcomes following hemihepatectomy [ 6 , 7 , 10 , 27 ]. We exhaustively evaluated all postoperative events, including delay in return of normal bowel function, which was surprisingly not improved among patients undergoing LHH.…”

Section: Discussionmentioning

confidence: 99%

“…Aside from increased complexity, cost associated with LHH can also be increased, in particular related to the use of more expensive surgical instruments and devices and longer operative times versus open hemihepatectomy (OHH). Cost analyses have determined that operative costs may be significantly higher for LHH than for OHH, though the increase in upfront cost may be offset, at least in part, by improved and less costly postoperative recovery and hospital stay [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open hemihepatectomy: comprehensive comparison of complications and costs at 90 days using a propensity method

et al. 2020

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Laparoscopic hemihepatectomy (LHH) may offer advantages over open hemihepatectomy (OHH) in blood loss, recovery, and hospital stay. The aim of this study is to evaluate our recent experience performing hemihepatectomy and compare complications and costs up to 90 days following laparoscopic versus open procedures. Retrospective evaluation of patients undergoing hemihepatectomy at our center 01/2010–12/2018 was performed. Patient, tumor, and surgical characteristics; 90-day complications; and costs were analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. A total of 141 hemihepatectomies were included: 96 OHH and 45 LHH. While operative times were longer for LHH, blood loss and transfusions were less. At 90 days, there were similar rates of liver-specific and surgical complications but fewer medical complications following LHH. Medical complications that arose with greater frequency following OHH were primarily pulmonary complications and urinary and central venous catheter infections. Complications at 90 days were lower following LHH (Clavien–Dindo grade ≥ III OHH 23%, LHH 11%, p = 0.130; Comprehensive Complication Index OHH 20.0 ± 16.1, LHH 10.9 ± 14.2, p = 0.001). While operating costs were higher, costs for hospital stay and readmissions were lower with LHH. Patients undergoing LHH experience a significant reduction in postoperative medical complications and costs, resulting in 90-day cost equity compared with OHH.

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