Beyond Survival: Complications and Care Delivery Outcomes Following Early Liver Cancer Treatment in a Nationally Representative Cohort.

PURPOSE: To compare secondary outcomes following ablation (AB), surgical resection (SR) and liver transplant (LT) for small hepatocellular carcinomas including resource utilization and adverse event (AE) rates.

MATERIALS AND METHODS: Using Surveillance, Epidemiology, and End Results Program-Medicare, HCCs less than 5 cm that were treated with AB, SR, or LT in 2009 to 2016 (n = 1,067) were identified using Healthcare Common Procedure Coding System codes through Medicare claims. Index procedure length of stay, need for ICU level care, readmission rates and AE rates at 30 and 90 days were compared using Chi-square tests or Fisher exact tests. Examined AEs included hemorrhage, abscess formation, biliary injury, pneumonia, sepsis, liver-disease related AEs, liver failure, and anesthesia related AEs, identified by ICD-9/10 codes.

RESULTS: The median length of stay for initial treatment was 1 day, 6 days and 7 days for AB, SR and LT, respectively (p-value <0.001). During initial hospital stay, 5.0%, 40.8% and 63.4% of AB, SR and LT cohorts, respectively, received ICU level care (p-value <0.001). By 30 and 90 days, there were significant differences between the AB, SR and LT cohorts in the rate of post-procedure hemorrhage, abscess formation, biliary injury, pneumonia, sepsis, liver disease related AEs, and anesthesia-related AEs (p-values < 0.05). By 90 days, the readmission rates following AB, SR and LT were 18.6%, 28.2% and 40.6% (p-value <0.001).

CONCLUSION: AB results in significantly less healthcare utilization during the initial 90 days post-procedure compared to SR and LT due to shorter length of stay, lower intensity care, fewer readmissions and fewer AEs.