Hospital costs of complications following liver resection surgery

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Hepatic resection remains the standard of care for both malignant and benign tumours of the liver, despite numerous advances in tumour ablation, targeted radiation therapy, immunotherapy, and chemotherapy for liver cancers and related pathologies. As perioperative outcomes have improved over the last two decades, along with developments in the diagnosis and management of liver tumours, indications for hepatic resection have broadened. Accordingly, increasing knowledge of liver anatomy and physiology, alongside improving outcomes following hepatic resection, has fostered an increase in the complexity and extent of disease that is considered operable, with repeat and two-stage resections becoming increasingly more common. Increasing complexity and extent of hepatic resection carries an increase in the incidence and severity of postoperative complications, with typically more than 50% of patients experiencing complications even in high volume centres. Complications following liver resection not only carry a substantial clinical burden, they also place a growing economic burden upon healthcare providers. Complications present the greatest contribution to increased costs following hepatic resection, and consequently provide an important target for interventions seeking to reduce healthcare expenditure. As the demand for healthcare grows, utilising limited resources in an era of mounting costs is becoming paramount in maintaining an effective and universally available healthcare system. Despite this, there is limited health economic data available on the topic of hepatic resection, and even less so quantifying the cost of complications. Aiming to address this need, we aim to identify the relationship between the extent of liver resection, the incidence and severity of complications, and the ensuing costs. Additionally, we seek to examine the sources of cost differentials between complicated and uncomplicated patients. Secondary objectives aim to assess the impact of surgical technique on the incidence and severity of complications and associated costs. We also aim to identify patient and anaesthetic factors associated with the clinical and economic outcomes. We hypothesised that as more extensive hepatic resection was performed the incidence and severity of complications would increase, and accordingly an increase in costs would be associated.

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