title: Minimally Invasive vs. Open Hepatectomy: a Comparative Analysis of the National Surgical Quality Improvement Program Database.
abstract: While minimally invasive surgery (MIS) to treat liver tumors has increased, data on perioperative outcomes of MIS relative to open liver resection (O-LR) are lacking. We sought to compare short-term outcomes among patients undergoing MIS vs. O-LR in a nationally representative database.
  
  
  
  The National Surgical Quality Improvement Program database was used to identify patients undergoing hepatectomy between January 1 and December 31, 2014. Propensity score matching algorithm was used to balance differences in baseline characteristics among MIS and O-LR groups.
  
  
  
  A total of 3064 patients were included in the study. After propensity matching, the baseline characteristics for O-LR and MIS groups were comparable (minimum p value = 0.12). Incidence of superficial surgical site infections, intraoperative or postoperative blood transfusions, and pulmonary embolism was lower among patients in MIS group compared to O-LR (p < 0.02). Liver failure and biliary leakage were also less frequent among patients undergoing MIS (p < 0.01). Similarly, MIS was associated with a shorter length of hospital stay (LOS) compared to O-LR (p < 0.001). Of note, 30-day postoperative mortality and readmission were comparable between the two groups.
  
  
  
  Patients undergoing MIS had a lower postoperative morbidity and shorter LOS compared with patients undergoing O-LR. MIS is safe and may be associated with improved short-term outcomes following hepatic surgery.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bagante
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: American College of Surgeons - National Surgical Quality Improvement Program, Chicago, IL, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Thompson
authors.affiliation: Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D017093:Liver Failure / Q000453:epidemiology; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D011184:Postoperative Period; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology*
keywords: Laparoscopic surgery; Liver surgery; Minimally invasive surgery; Robotic surgery