Cost of Major Complications After Liver Resection in the United States: Are High-volume Centers Cost-effective?

Objective: The aim of the study was to estimate the cost of major complications after liver resection and determine whether high-volume (HV) centers are cost-effective. Methods: From 2002 to 2011, 96,107 cases of liver resection performed in the United States were identified using Nationwide Inpatient Sample. Hospitals were categorized as HV (150+ cases/yr), medium-volume (51–149 cases/yr), and low-volume (LV) (1–50 cases/yr) centers. Multivariable regression analysis identified predictors of cost. Propensity score matching comparing cases with versus without complications and costs of specific complications were estimated. Cost-effectiveness of HV centers was determined by calculating the incremental cost-effectiveness ratio. Results: After propensity score matching, the occurrence of a major complication added $33,855 extra cost, increased mean length of stay by 8.7 [95% confidence interval (CI), 8.4–9] days and increased risk of death by 9.3% (all P

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