Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies.

BACKGROUND

Liver biopsy is an important tool in the management of patients with liver disease. Because biopsy practices may be changing, we studied patterns of use in a large Canadian Health Region. We aimed to describe trends in biopsy utilization and the incidence and costs of complications from a population-based perspective.

METHODS

Administrative databases were used to identify percutaneous liver biopsies performed between 1994 and 2002. Significant complications were identified by reviewing medical records of patients hospitalized within 7 days of a biopsy and those with a diagnostic code indicative of a procedural complication. Analyses of biopsy rates employed Poisson regression.

RESULTS

Between 1994 and 2002, 3627 patients had 4275 liver biopsies (median 1 per patient; range 1-12). Radiologists performed the majority (90%), particularly during the latter years (1994 vs. 2002: 73 vs. 98%; P<0.0001). The overall annual biopsy rate was 54.8 per 100 000 population with a 41% (95% CI 23-61%) increase between 1994 and 2002. Annual increases were greatest in males and patients 30-59 years. Thirty-two patients (0.75%) had significant biopsy-related complications (1994-1997 vs. 1998-2002: 1.28 vs. 0.44%; P=0.003). Pain requiring admission (0.51%) and bleeding (0.35%) were most common. Six patients (0.14%) died; all had malignancies. The median direct cost of a hospitalization for complications was $4579 (range $1164-29 641).

CONCLUSIONS

Liver biopsy rates are increasing likely owing to the changing epidemiology and management of common liver diseases. The similarity of the complication rate in our population-based study with estimates from specialized centres supports the safety of this important procedure.