National Trends in Postoperative Outcomes and Cost Comparing Minimally Invasive Versus Open Liver and Pancreatic Surgery

Victor Okunrintemi, Faiz Gani, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Sep 9 2016
Externally publishedYes

Keywords

  • Costs
  • Liver
  • MIS
  • Open
  • Outcome
  • Pancreas
  • Trends

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Gastroenterology

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