title: Twenty-year audit of percutaneous liver biopsy in a major Australian teaching hospital.
abstract: BACKGROUND
  To examine the changes in indications, patient characteristics, safety and outcomes in consecutive patients undergoing percutaneous core liver biopsies in a major Australian teaching hospital over a period of two decades.
  
  
  METHODS
  A retrospective audit was carried out on all percutaneous core liver biopsies from a single institution between 1996 and 2005. This was combined with 10 years of data already reported on for the years 1986-1995 to detect trends in indications and outcomes.
  
  
  RESULTS
  Medical records from 1398 patients were included for analysis. Over a 20-year period, the most common indications for liver biopsy were hepatitis C (37.8%), hepatitis B (26.4%) and abnormal liver function tests (22.2%). Twelve major complications (1.0%) were seen; 10 episodes of haemorrhage, 1 bile leak and 1 visceral perforation. Seven of these patients had an abnormal baseline coagulation profile; a significant risk for major haemorrhage (P < 0.001), resulting in three deaths. All deaths occurred in inpatients with major comorbidities. Minor complications occurred in 13.6% of patients, with multiple passes a significant risk factor. Whereas the overall major and minor complication rates were independent of operator experience inadequate specimens were more frequently obtained by the registrar.
  
  
  CONCLUSIONS
  This large series extending over two decades shows that despite advances in biopsy techniques, the rates of both minor and major complications remain significant. Of particular concern are the procedure-related deaths. Identifying factors that may increase risk requires further scrutiny and careful patient selection needs to be undertaken.
authors.affiliation: Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia. davidvdp@ozemail.com.au
authors.forename: D
authors.initials: D
authors.lastname: van der Poorten
authors.forename: A
authors.initials: A
authors.lastname: Kwok
authors.forename: T
authors.initials: T
authors.lastname: Lam
authors.forename: L
authors.initials: L
authors.lastname: Ridley
authors.forename: D B
authors.initials: DB
authors.lastname: Jones
authors.forename: M C
authors.initials: MC
authors.lastname: Ngu
authors.forename: A U
authors.initials: AU
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000473:pathology*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies