National trends in surgical procedures for hepatocellular carcinoma: 1998-2008

BACKGROUND: The incidence of hepatocellular carcinoma (HCC) is rising, and the options for surgical therapy of HCC have evolved recently, but use of surgical therapy has not been characterized on a representative, nationwide basis.We quantified trends in use, mortality, and patient and hospital characteristics for 3 surgical therapies for HCC (resection, ablation, and transplantation) in the United States from 1998 to 2008. METHODS: Hospital discharge data from the Nationwide Inpatient Sample were used to quantify procedure-related data for each year. Trends over time were summarized as the average annual percent change (AAPC) and corresponding 95% confidence interval (CI). RESULTS: The number of surgical procedures for HCC increased from 1416 to 6769 (AAPC, 13.5%; 95% CI, 10.2%-16.8%). Volumes increased for all surgical procedures, most notably for ablation (AAPC, 17.3%; 95% CI, 6.6%- 29.2%) and transplantation (AAPC, 20.9%; 95% CI, 14.1%-28.1%). When analyzed as a proportion of total procedures, there were declines in the relative use of major hepatectomy (35% to 16%; AAPC, -7.2%, 95% CI, -8.8% to -5.6%) and wedge resection (37% to 22%; AAPC, -4.8%; 95% CI, -6.2% to -3.4%), while the proportion accounted for by transplantation increased (16% to 35%; AAPC, 4.4%; 95% CI, 0.2%-8.9%). Inpatient mortality decreased for each procedure individually and overall from 7.3% to 4.6% (AAPC, -7.7%; 95% CI, -10.8% to -4.5%), despite increasing age and comorbidity burden. CONCLUSIONS: The use of surgical therapy for HCC has increased dramatically over the last decade, with a relative shift away from liver resection and toward liver transplantation. These therapeutic modalities must be better targeted to make the most appropriate use of limited health care resources.