title: Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Liver Unit, University of Calgary, Calgary, AB, Canada. rpmyers@ucalgary.ca
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.forename: Andrew
authors.initials: A
authors.lastname: Fong
authors.forename: Abdel Aziz M
authors.initials: AA
authors.lastname: Shaheen
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged