Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2016; 22(46): 10189-10197
Published online Dec 14, 2016. doi: 10.3748/wjg.v22.i46.10189
Use of a saline-coupled bipolar sealer open liver resection for hepatic malignancy: Medical resource use and costs
Christine I Nichols, Joshua G Vose
Christine I Nichols, Joshua G Vose, Medtronic Advanced Energy, 180 International Drive, Portsmouth, NH 03801, United States
Author contributions: Nichols CI and Vose JG designed the research; Nichols CI performed data analyses; Nichols CI and Vose JG analyzed the data; and Nichols CI and Vose JG wrote the paper and revisions.
Institutional review board statement: Given this study used de-identified patient data, it was not subject to Institutional Review Board approval. The study dataset and full study tables are available from the corresponding author.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joshua G Vose, MD, Medical Director, Medtronic Advanced Energy, 180 International Drive, Portsmouth, NH 03801, United States. joshua.vose@medtronic.com
Telephone: +1-603-8424623 Fax: +1-603-7421488
Received: August 5, 2016
Peer-review started: August 6, 2016
First decision: September 21, 2016
Revised: October 11, 2016
Accepted: November 15, 2016
Article in press: November 16, 2016
Published online: December 14, 2016
Processing time: 129 Days and 19.9 Hours
Abstract
AIM

To evaluate outcomes associated with use of a saline coupled bipolar sealer during open partial liver resection.

METHODS

This retrospective analysis utilized the United States Premier™ insurance claims database (2010-2014). Patients were selected with codes for liver malignancy and partial hepatectomy or lobectomy. Cases were defined by use the saline-coupled bipolar sealer; controls had no use. A Propensity Score algorithm was used to match one case to five controls. A deviation-based cost modeling (DBCM) approach provided an estimate of cost-effectiveness.

RESULTS

One hundred and forty-four cases and 720 controls were available for analysis. Patients in the case cohort received fewer transfusions vs controls (18.1% vs 29.4%, P = 0.007). In DBCM, more patients in the case cohort experienced “on-course” hospitalizations (53.5% vs 41.9%, P = 0.009). The cost calculation showed an average savings in total hospitalization costs of $1027 for cases vs controls. In multivariate analysis, cases had lower odds of receiving a transfusion (OR = 0.44, 95%CI: 0.27-0.71, P = 0.0008).

CONCLUSION

Use of a saline-coupled bipolar sealer was associated with a greater proportion of patients with an “on course” hospitalization.

Keywords: Liver resection; Hepatocellular carcinoma; Costs

Core tip: This study evaluated outcomes associated with use of a saline coupled bipolar sealer during open partial liver resection. Using US Premier insurance claims data, Cases with use of the saline-coupled bipolar sealer (SCBS) were propensity-score matched to controls with no use. A deviation-based cost modeling (DBCM) approach provided an estimate of cost-effectiveness. Results demonstrated that use of the SCBS in open partial liver resection for hepatic malignancy is associated with reduction in the need for transfusion, and is cost-effective in a DBCM analysis. This technology provides an alternative solution for bleeding control in partial liver resection compared to traditional methods.