OBJECTIVES: The advantage of minimally invasive surgery (MIS) in reducing the incidence of complications has been widely recognized. The objective of this study was to assess the risk of complications with MIS in comparison with open procedures in liver resection using a real-world data set.

METHODS: The study was conducted using the Premier Perspective® Database that contains a nationally representative sample of discharges from over 600 hospitals in the U.S. Included patients were ³18 years of age and had a liver resection from October 2015 to December 2016, when ICD-10 procedure codes were available for direct identification of MIS. All complications were reviewed, and those with highest frequencies were examined. To determine the association of MIS with complications, multivariable logistic regression models were built with a broad range of predictor variables, including surgical approach (MIS vs Open), demographics, procedure and hospital characteristics.

RESULTS: A total of 1,097 patients underwent liver resection, 22.6% (N=248) received MIS and 77.4% (N=849) received traditional open surgery. Compared to Open patients, MIS patients had higher a proportion of female patients (58.1% vs. 48.3%) and lower proportion of patients with a cancer diagnosis (48.4% vs 67.4%). Bleeding was the most frequent complication with an incidence of 16.6%, followed by respiratory failure (10.4%), intestinal obstruction (5.7%), and pleural effusion (4.6%). In the logistic regression model, MIS patients were less likely to have bleeding events with odds ratios (OR) of 0.342 (95% confidence interval: 0.196-0.598, p=0.0002) compared to the Open group. Similar trends for other complications were observed. The odds ratios (95% CI, p value) for respiratory failure, intestinal obstruction, and pleural effusion were 0.178 (0.074-0.429, p =0.001), 0.309 (0.118-0.813, p=0.0173), and 0.236 (0.063-0.889, p=0.0328), respectively.

CONCLUSIONS: This study suggests that MIS is associated with significantly lower risk of major complications in liver resection.