title: Laparoscopic vs open right hepatectomy: a value-based analysis.
abstract: BACKGROUND
  Current literature lacks sufficient data on outcomes after extensive laparoscopic liver resections. We hypothesized that laparoscopic right hepatectomy (LRH) is associated with better clinical outcomes and less overall hospital costs than open right hepatectomy (ORH), supporting the notion that major laparoscopic hepatic resections carry increased value when compared with the open approach.
  
  
  METHODS
  We reviewed medical records of all patients at our institution who underwent elective LRH (n = 48) or ORH (n = 57) from May 16, 2008 to March 1, 2012. Patient demographics, preoperative comorbidities, operative details, and postoperative outcomes were compared between the 2 groups. Hospital billing data were collected for each case to determine the average hospital costs per case.
  
  
  RESULTS
  Average operative duration, estimated blood loss, intravenous fluid resuscitation requirements, high-grade postoperative complications, the need for postoperative admission to the ICU, and hospital length of stay were significantly less within the LRH cohort. Thirty-day mortality and readmission rates were equivalent between the 2 groups. Despite higher operative costs for LRH ($16,605 vs $10,411, p < 0.001), total postoperative costs were significantly less ($9,075 for LRH vs $16,341 for ORH, p < 0.001), resulting in equivalent overall costs ($25,679 for LRH vs $26,751 for ORH, p = 0.65).
  
  
  CONCLUSIONS
  Although overall costs between LRH and ORH are equivalent, clinical outcomes after LRH are comparable to those after ORH, supporting the value of laparoscopy in extensive right hepatic resections. Efforts to reduce operative costs of LRH, while maintaining optimal patient outcomes, should be the focus of surgeons and hospitals moving forward.
authors.affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Medbery
authors.affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Tatiana S
authors.initials: TS
authors.lastname: Chadid
authors.affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.affiliation: Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Edward
authors.initials: E
authors.lastname: Lin
authors.affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address: jsarmie@emory.edu.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
mesh_terms: D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000191:economics / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies