title: Short-term outcomes of ablation therapy for hepatic tumors: evidence from the 2006-2009 nationwide inpatient sample.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) for the treatment of hepatic tumors has been increasingly used across the United States. Whether treatment-related morbidity has remained low with broader adoption is unclear. We conducted this study to describe in-hospital morbidity associated with RFA for hepatic tumors and to identify predictors of adverse events in a nationally representative database.
  
  
  METHODS
  Using the 2006-2009 Nationwide Inpatient Sample, we evaluated all patients aged ≥40 years who underwent an elective RFA for primary or metastatic liver tumors (N = 1298). Outcomes included in-hospital procedure-specific and postoperative complications. Multivariable logistic regression analyses were performed to identify patient and facility predictors of complications.
  
  
  RESULTS
  Most patients underwent a percutaneous (39.9 %) or laparoscopic (22.0 %) procedure for metastatic liver tumors (57.5 %). Procedure-specific complications were frequent (18.2 %), with transfusion requirements (10.7 %), intraoperative bleeding (4.3 %), and hepatic failure (2.8 %) being the most common. Arrhythmias [adjusted odds ratio (AOR) = 1.93 (1.23-3.04)], coagulopathy [AOR = 4.65 (2.95-7.34)], and an open surgical approach [AOR = 2.77 (1.75-4.36)] were associated with an increased likelihood of procedure-specific complications, whereas hospital RFA volume ≥16/year was associated with a reduced likelihood [AOR = 0.59 (0.38-0.91)]. Postoperative complications were also common (12.0 %), with arrhythmias, heart failure, coagulopathy, and open surgical approach acting as significant predictors.
  
  
  CONCLUSIONS
  In-hospital morbidity is common after RFA for hepatic tumors. While several patient factors are associated with more frequent procedure-specific complications, treatment at hospitals with an annual volume ≥16 cases/year was associated with a 41 % reduction in the odds of procedure-specific complications.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.forename: Joshua
authors.initials: J
authors.lastname: Gustafson
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: Minia
authors.initials: M
authors.lastname: Hellan
authors.forename: Thav
authors.initials: T
authors.lastname: Thambi-Pillai
authors.forename: James
authors.initials: J
authors.lastname: Ouellette
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D015897:Comorbidity; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D014481:United States