Trend and cost analysis comparing laparoscopic versus open liver resections at a Tertiary Referral hospital in...

Minimally invasive methods for liver resection operations have increased throughout the world. We aimed to determine the trends and cost differences in liver resections conducted by open and laparoscopic approaches at a teaching hospital in South Australia.

We conducted a retrospective analysis of 284 liver resections (247 open (OLR); 37 laparoscopic (LLR); subgroup analysis of 135 major and 149 minor) at Flinders Medical Centre between the 2013/14 and 2021/22 financial years. Trends were calculated using Mann Kendall and statistical analysis was conducted using the Welch t-test.

87% of all resections, 98% major, and 77% of minor resections were OLRs. There was a significant decrease in the number of liver resections in total (tau = -0.686, p $<$ 0.05) and OLR (tau = -0.817, p < 0.05). OLR had a significantly higher length of stay ( $8.17\pm 6.34$ days) vs. LLR $(4.35\pm 3.4$ days) (p $<$ 0.001) in total and for minor resections ( $4.30\pm 3.43$ days vs $7.45\pm 5.05$ days, p $<$ 0.001). OLR also had a significantly higher total cost ( $\$42,873\pm 20182\mathrm{vs}.\$23,958\pm 14,700,$ p $<$ 0.001) in total and minor resections ( $\$21,982\pm 10,344$ vs. $\$38,210\pm 16,936$ , p $<$ 0.001). Operating room (OR) was the largest cost bucket in total and subgroup analysis. LLR had a significantly lower OR cost in total ( $\$9,079\pm 5,160\mathrm{vs}\$14,238\pm 5,739$ , p $<$ 0.001) and in minor resections ($ $8,891\pm 3,671$ VS. $12,225\pm 4,794$ , p $<$ 0.001).

Over the study period there has been a decrease in the total number of liver resections, especially OLR. LLR can reduce costs in appropriately selected patients.