Computed tomography (CT)-guided versus laparoscopic radiofrequency ablation: a single-institution comparison of morbidity rates and hospital costs.
BACKGROUND
Computed tomography (CT)-guided radiofrequency ablation (RFA) is presumed to be less morbid and less costly than laparoscopic RFA. This analysis investigates the 30-day morbidity, hospital cost, and reimbursement for CT-guided RFA versus laparoscopic RFA used to manage hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM).


METHODS
A retrospective review was performed for all patients with CRLM or HCC who underwent CT-guided RFA or laparoscopic RFA between January 2002 and August 2008. Demographics, risk stratification, and procedural data were analyzed. Hospital financial data were queried for total cost, reimbursement, and itemized departmental charges. The CRLM and HCC patients were evaluated separately.


RESULTS
The study analyzed 18 RFA procedures for the treatment of HCC (8 CT-guided RFA; 10 laparoscopic RFA) and 25 RFA procedures for the treatment of CRLM (6 CT-guided RFA; 19 laparoscopic RFA). Immediate local failures were reported for 33.3% and 12.5% of the CT-guided RFA procedures for CRLM and HCC and for 5.2% and 0.0% of the laparoscopic RFA procedures for CRLM and HCC, respectively. The mean hospital cost was higher for the patients who underwent laparoscopic RFA ($11,808.70 ± $7,238.90 for HCC vs $9,882.40 ± $1,926.90 for CRLM) than for those who underwent CT-guided RFA ($7,186.10 ± $3,899.60 for HCC vs $5,767.50 ± $2,869.00 for CRLM). The mean reimbursement was lower than the mean hospital cost for the patients who underwent CT-guided RFA for CRLM ($4,329.10 vs $5,767.50).


CONCLUSIONS
Although CT-guided RFA is less expensive, it is poorly reimbursed. Also, CT-guided RFA is associated with a higher immediate local failure rate for both CRLM and HCC and a higher complication rate for patients with CRLM. For patients with HCC, CT-guided RFA is associated with a lower complication rate. Our data suggest that laparoscopic RFA should be used for most patients with CRLM and only selectively for patients with HCC.
Cassera
Maria A
MA
Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, 4805 NE Glisan St., Suite 6N50, Portland, OR 97213, USA.
Potter
Kevin W
KW
Ujiki
Michael B
MB
Swanström
Lee L
LL
Hansen
Paul D
PD
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000191:economics; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D017115:Catheter Ablation / Q000191:economics / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology; D016208:Databases, Factual; D054810:Deep Sedation / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009922:Oregon; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D015641:Radiography, Interventional / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods*