National utilization of minimally invasive and open liver resections

Abstract Introduction Although minimally invasive (MIS) liver resections are associated with improved outcomes, uptake remains slow. Methods Using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), adults who underwent elective liver resections (2016–2020) were identified. Approach was classified as MIS (laparoscopic or robotic-assisted) or open. Annual utilization was characterized by approach and association between approach and patient and hospital variables was estimated. Results Among 63,280 adult liver resections, 22.5% were MIS. MIS resections increased from 21.3% in 2016 to 22.5% in 2020. Laparoscopy alone decreased from 18.4 to 14.9%, while robotic-assistance increased from 2.9 to 7.6%. In multivariable analysis, patients were less likely to undergo MIS resection if they were in a county with < 250,000 people (vs. > 250,000, OR [95% CI], 0.82 [0.73–0.93]). Patients were more likely to undergo a MIS resection if they had a benign indication (vs. malignancy, OR [95% CI], 2.9 [2.49–3.38]), or were undergoing a partial hepatectomy (vs. lobectomy, OR, [95% CI], 2.62 [2.24–3.07]). Conclusion MIS liver resection increased between 2016 and 2020, driven by an increase in robotic-assisted surgery and despite a reduction in laparoscopic surgery. Rurality, indication, and resection type were contributors to a MIS vs. open approach.