title: Financial comparison of laparoscopic versus open hepatic resection using deviation-based cost modeling.
abstract: BACKGROUND
  There is a growing body of evidence suggesting the equivalence and in some cases superiority of laparoscopic liver resection versus open resection. Fewer data exist regarding the financial impact of laparoscopic liver resection.
  
  
  METHODS
  Retrospective review of 98 consecutive patients at a single institution from 2007 through 2011 undergoing first time hepatic resection was performed. Laparoscopic and open cases were compared primarily on OR and hospital charges. Deviation-based cost modeling and weighted average mean cost for the two procedures were used to determine both financial and clinical efficacy on the basis of differences in length of stay, complications, and charges.
  
  
  RESULTS
  There were 57 laparoscopic and 41 open cases included in the study. Right hepatectomy was the most common procedure performed in both the laparoscopic (n=23, 40.4%) and open (n=22, 53.7%) groups. Patients in the laparoscopic group were significantly more likely to have an "on course" postoperative hospitalization (73.7 vs. 26.8%; p<0.001), which translated into a WAMC of $58,401 for the laparoscopic cases and $69,728 for the open cases. In the subset of patients undergoing right hepatectomy, patients in the laparoscopic group remained more likely to have an on course hospitalization (61.2 vs. 31.8%; p=0.025). WAMC for the laparoscopic right hepatectomy group, however, was higher than the open group ($69,544 vs. $68,266).
  
  
  CONCLUSIONS
  The cost-effectiveness of laparoscopic hepatectomy appears to vary with the complexity of the procedure. Overall, laparoscopy offers a cost advantage; however, with more complex procedures such as right hepatectomy, higher up-front operating room charges offset the financial benefits of less complicated hospitalization.
authors: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
authors: Robert M
authors: RM
authors: Cannon
authors: Charles R
authors: CR
authors: Scoggins
authors: Glenda G
authors: GG
authors: Callender
authors: Amy
authors: A
authors: Quillo
authors: Kelly M
authors: KM
authors: McMasters
authors: Robert C G
authors: RC
authors: Martin
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000473:pathology / Q000601:surgery; D015179:Colorectal Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000191:economics* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate