Scientific Session 09 — SS09: Vascular/Interventional - Hepatic Interventions/Interventional OncologyTuesday, May 7, 2019
2786. Percutaneous Ablation vs. Surgery for Hepatocellular Carcinoma: A National Analysis of Hospitalizations and Short-term Outcomes, 2002-2015
Sodagari F1*, Golnari P2, Chapiro J1, Jahromi B2, Yaghmai V3 1. Yale University School of Medicine, New Haven, CT; 2. Northwestern University, Chicago, IL; 3. Feinberg School of Medicine, Chicago, IL
Address correspondence to F. Sodagari (firstname.lastname@example.org)
Objective: To compare population-wide use rates and outcomes of percutaneous liver ablation interventions (IRs) versus surgical procedures for hepatocellular carcinoma (HCC).
Materials and Methods: With ICD-9 codes, all hospitalizations from 2002 to 2015 for patients with the diagnosis of HCC were identified in the National Inpatient Sample database, which is the largest all-payer inpatient care database in the United States, accounting for approximately 20% of all annual discharges weighted to provide national estimates. Hospitalizations with coexisting diagnoses of secondary hepatic and primary biliary malignancies, neuroendocrine tumors and benign hepatobiliary neoplasms, and traumatic lacerations were excluded. Percutaneous ablative interventions were compared to surgical procedures on use rates, and outcomes including inhospital mortality, routine discharge, length of hospital stay (LOS) and hospitalization cost by Poisson regression. Risk ratios (RRs) were adjusted for patient-specific and hospital-specific factors, comorbidity score, and hospitalization year.
Results: A total of 557,071 hospitalizations in patients with HCC were extracted, with an estimated 13,618 (2.4%) IRs and 44,629 (8.0%) surgical procedures performed. During the 14-year period, hospitalizations for HCC increased from 22,231 in 2002 to 54,427 in 2015, with a median annual percentage increase of 4.4 (range, -5.6% in 2006 to 27% in 2007). Unadjusted inhospital mortality rate, LOS, and hospitalization cost were higher for surgical procedures (4.5% vs 1%, 10.7±6 vs 3.3±2 days, $51,656 vs $13,243, respectively; all P values < 0.001). After adjusting for comorbidity score, year, and patient- and hospital-specific factors, IR was associated with 78% lower inhospital mortality (RR: 0.22; 95% CI: 0.18-0.27), 37% higher routine discharge to home (RR: 1.37; 95% CI: 1.36-1.39), 67% lower LOS (RR: 0.33; 95%CI: 0.32-0.34), and 71% lower cost (RR: 0.29; 95%CI: 0.29-0.30) (all P values < 0.001). Age greater than 50, male sex, black and Hispanic race, public (vs private) insurance coverage, and nonteaching urban hospital setting are significant predictors of undergoing IR intervention versus surgery, after adjusting for confounding factors.
Conclusion: There is a continued increase in hospitalizations for patients with hepatocellular carcinoma. Compared to surgical procedures, percutaneous liver ablative IRs in patients with HCC are associated with lower inhospital mortality, LOS, and hospitalization costs, even after adjusting for comorbidities, year, and patient- and hospital-specific factors.