National Trends in Postoperative Outcomes and Cost Comparing Minimally Invasive Versus Open Liver and Pancreatic Surgery.
Although minimally invasive surgery (MIS) has been associated with improved postoperative clinical outcomes, the widespread use of MIS by procedure and hospital has been limited. We sought to report on national trends postoperative clinical outcomes for minimally invasive liver and pancreatic surgery.



Patients undergoing an elective liver or pancreatic resection were identified using the Nationwide Inpatient Sample between 2002 and 2012. Multivariable regression analysis was used to compare postoperative outcomes, and total hospital costs between patients who underwent a MIS versus an open resection over the study time period.



A total of 47,685 patients were identified; 21,280 (44.6 %) patients underwent a hepatic resection while 26,405(55.4 %) patients underwent a pancreatic resection. MIS was performed in 2674 (5.6 %) patients and increased from 2.6 % in 2002 to 9.6 % in 2012 (p < 0.001); this trend was observed for both pancreatic and liver resections (both p < 0.001). Over the study time period, use of MIS was consistently associated with improved postoperative outcomes including decreased postoperative morbidity (open vs. MIS: 32.9 vs. 29.6 %) and a shorter length-of-stay (≤4 days; MIS, 21.4 %; Open, 13.7 %; both p < 0.05). The median costs associated with MIS decreased over time compared with the open surgical approach and were on average $572 lower than the cost associated with open surgery.



Compared to open resection, MIS was associated with lower postoperative morbidity, a shorter length-of-stay, and lower cost. The use of MIS should be encouraged in order to improve postoperative outcomes and decrease healthcare spending via value enhancement.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Victor
V
Okunrintemi
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Faiz
F
Gani
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center at The Ohio State University, 395 W. 12th Avenue, Suite 670, Columbus, OH, 43210, USA. tim.pawlik@osumc.edu.
Timothy M
TM
Pawlik
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006498:Hepatectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Costs; Liver; MIS; Open; Outcome; Pancreas; Trends