Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
J Am Coll Surg. 2014 May;218(5):929-39. doi: 10.1016/j.jamcollsurg.2014.01.045. Epub 2014 Feb 14.
Current literature lacks sufficient data on outcomes after extensive laparoscopic liver resections. We hypothesized that laparoscopic right hepatectomy (LRH) is associated with better clinical outcomes and less overall hospital costs than open right hepatectomy (ORH), supporting the notion that major laparoscopic hepatic resections carry increased value when compared with the open approach.
We reviewed medical records of all patients at our institution who underwent elective LRH (n = 48) or ORH (n = 57) from May 16, 2008 to March 1, 2012. Patient demographics, preoperative comorbidities, operative details, and postoperative outcomes were compared between the 2 groups. Hospital billing data were collected for each case to determine the average hospital costs per case.
Average operative duration, estimated blood loss, intravenous fluid resuscitation requirements, high-grade postoperative complications, the need for postoperative admission to the ICU, and hospital length of stay were significantly less within the LRH cohort. Thirty-day mortality and readmission rates were equivalent between the 2 groups. Despite higher operative costs for LRH ($16,605 vs $10,411, p < 0.001), total postoperative costs were significantly less ($9,075 for LRH vs $16,341 for ORH, p < 0.001), resulting in equivalent overall costs ($25,679 for LRH vs $26,751 for ORH, p = 0.65).
Although overall costs between LRH and ORH are equivalent, clinical outcomes after LRH are comparable to those after ORH, supporting the value of laparoscopy in extensive right hepatic resections. Efforts to reduce operative costs of LRH, while maintaining optimal patient outcomes, should be the focus of surgeons and hospitals moving forward.
目前的文献缺乏广泛腹腔镜肝切除术后结局的充分数据。我们假设腹腔镜右半肝切除术（LRH）与开腹右半肝切除术（ORH）相比，具有更好的临床结局和更低的总住院费用，支持这样一种观点，即与开腹手术相比，主要的腹腔镜肝切除术具有更高的价值。
我们回顾了 2008 年 5 月 16 日至 2012 年 3 月 1 日期间我院所有接受择期 LRH（n=48）或 ORH（n=57）的患者的病历。比较两组患者的人口统计学特征、术前合并症、手术细节和术后结局。收集每个病例的住院计费数据，以确定每个病例的平均住院费用。
LRH 组的平均手术时间、估计失血量、静脉输液复苏需求、高级别术后并发症、术后入住 ICU 的需求以及住院时间均显著减少。两组 30 天死亡率和再入院率相当。尽管 LRH 的手术费用较高（16605 美元 vs. 10411 美元，p<0.001），但总术后费用显著较低（LRH 为 9075 美元，ORH 为 16341 美元，p<0.001），总费用相当（LRH 为 25679 美元，ORH 为 26751 美元，p=0.65）。
尽管 LRH 和 ORH 的总费用相当，但 LRH 后的临床结局与 ORH 相当，支持腹腔镜在广泛右半肝切除术中的价值。降低 LRH 手术成本的同时保持最佳患者结局应成为外科医生和医院关注的焦点。
