title: Cost-Effective Surgical Management of Liver Disease Amidst a Financial Crisis.
abstract: BACKGROUND
  Intraoperative use of specialized equipment and disposables contributes to the increasing cost of modern liver surgery. As a response to the recent severe financial crisis in our country we have employed a highly standardized protocol of liver resection that minimizes intraoperative and postoperative costs. Our goal is to evaluate cost-effectiveness of this protocol.
  
  
  METHODS
  We evaluated retrospectively all patients who underwent open hepatic resections for 4 years. All resections were performed by the same surgical team under selective hepatic vascular exclusion, i.e., occlusion of the hepatoduodenal ligament and the major hepatic veins, occasionally combined with extrahepatic ligation of the ipsilateral portal vein. Sharp parenchymal transection was performed with a scalpel and hemostasis was achieved with sutures without the use of energy devices. In each case we performed a detailed analysis of costs and surgical outcomes.
  
  
  RESULTS
  Our cohort included 146 patients (median age 63 years). 113 patients were operated for primary or metastatic malignancies and 33 for benign lesions. Operating time was 121 ± 21 min (mean ± SD), estimated blood loss was 310 ± 159 ml (mean ± SD), and hospital stay was 7 ± 5 days (mean ± SD). Six patients required admission in the ICU postoperatively. 90-day mortality was 2.74 %, and 8.9 % of patients developed grade III/IV postoperative complications (Clavien-Dindo classification). Total in-hospital cost excluding physician fees was 6987.63 ± 3838.51 USD (mean ± SD).
  
  
  CONCLUSIONS
  Our analysis suggests that, under pressing economic conditions, the proposed surgical protocol can significantly lessen the financial burden of liver surgery without compromising patient outcomes.
authors.affiliation: 4th Surgical Clinic, Attikon University Hospital, 1, Rimini Str., 12462, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.affiliation: 4th Surgical Clinic, Attikon University Hospital, 1, Rimini Str., 12462, Athens, Greece. georgegemen@gmail.com.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gemenetzis
authors.affiliation: 4th Surgical Clinic, Attikon University Hospital, 1, Rimini Str., 12462, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Danias
authors.affiliation: 4th Surgical Clinic, Attikon University Hospital, 1, Rimini Str., 12462, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kokoropoulos
authors.affiliation: 2nd Anesthesiology Clinic, Attikon University Hospital, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Koukopoulou
authors.affiliation: 4th Surgical Clinic, Attikon University Hospital, 1, Rimini Str., 12462, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Bartsokas
authors.affiliation: 2nd Anesthesiology Clinic, Attikon University Hospital, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kostopanagiotou
authors.affiliation: 4th Surgical Clinic, Attikon University Hospital, 1, Rimini Str., 12462, Athens, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D003362:Cost-Benefit Analysis; D057172:Economic Recession; D005260:Female; D006498:Hepatectomy / Q000191:economics* / Q000379:methods; D006503:Hepatic Veins / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008026:Ligation; D008107:Liver Diseases / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics*; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000191:economics*; D013537:Sutures / Q000191:economics*; D014481:United States