National trends with a laparoscopic liver resection: results from a population based analysis

BackgroundInterest in laparoscopic liver resection (LLR) has grown since the International ‘Louisville Statement’ regarding laparoscopic liver surgery was published in 2009. However, limited population based data on LLR utilization patterns and outcomes are available.MethodsLLR data from the Nationwide Inpatient Sample (NIS, 2000–2012) and the National Surgical Quality Improvement Project (NSQIP, 2005–2012) were compared before and after the Louisville Statement in 2009.ResultsIn total, 1131 and 642 LLR were identified from NIS and NSQIP, respectively. Three quarters of patients underwent LLR for a malignant indication (NIS primary malignancy, 29.6% versus metastasis, 45.1%; NSQIP primary malignancy, 35.5% versus metastasis, 46.1%). The annual volume of LLR increased from 2000–2008 versus 2009–2012 (NIS: 63 versus 168, P< 0.001; NSQIP: 52 versus 127; both P = 0.001). The peri operative mortality associated with LLR was 2.8% in NIS and 2.2% in NSQIP. The morbidity was 38.1% in NIS and 30.7% in NSQIP. Mortality and morbidity did not change over time (both P > 0.050). After 2009, LLR was associated with a shorter length of stay (LOS) (NIS: 5 versus 6 days, P = 0.007).ConclusionSince the Louisville Statement in 2009, utilization of LLR has increased. LLR is associated with a modest decrease in LOS and appears to be safe with mortality and morbidity similar to open surgery.