{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T10:58:50Z","timestamp":1715770730654},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,2,25]],"date-time":"2016-02-25T00:00:00Z","timestamp":1456358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2016,2,25]],"date-time":"2016-02-25T00:00:00Z","timestamp":1456358400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intraoperative use of specialized equipment and disposables contributes to the increasing cost of modern liver surgery. As a response to the recent severe financial crisis in our country we have employed a highly standardized protocol of liver resection that minimizes intraoperative and postoperative costs. Our goal is to evaluate cost\u2010effectiveness of this protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>We evaluated retrospectively all patients who underwent open hepatic resections for 4 years. All resections were performed by the same surgical team under selective hepatic vascular exclusion, i.e., occlusion of the hepatoduodenal ligament and the major hepatic veins, occasionally combined with extrahepatic ligation of the ipsilateral portal vein. Sharp parenchymal transection was performed with a scalpel and hemostasis was achieved with sutures without the use of energy devices. In each case we performed a detailed analysis of costs and surgical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our cohort included 146 patients (median age 63 years). 113 patients were operated for primary or metastatic malignancies and 33 for benign lesions. Operating time was 121 \u00b1 21\u00a0min (mean \u00b1 SD), estimated blood loss was 310 \u00b1 159\u00a0ml (mean \u00b1 SD), and hospital stay was 7 \u00b1 5\u00a0days (mean \u00b1 SD). Six patients required admission in the ICU postoperatively. 90\u2010day mortality was 2.74 %, and 8.9 % of patients developed grade III\/IV postoperative complications (Clavien\u2013Dindo classification). Total in\u2010hospital cost excluding physician fees was 6987.63 \u00b1 3838.51 USD (mean \u00b1 SD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our analysis suggests that, under pressing economic conditions, the proposed surgical protocol can significantly lessen the financial burden of liver surgery without compromising patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-016-3440-2","type":"journal-article","created":{"date-parts":[[2016,2,25]],"date-time":"2016-02-25T17:20:06Z","timestamp":1456420806000},"page":"1695-1701","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cost\u2010Effective Surgical Management of Liver Disease Amidst a Financial Crisis"],"prefix":"10.1002","volume":"40","author":[{"given":"Nikolaos","family":"Arkadopoulos","sequence":"first","affiliation":[{"name":"4th Surgical Clinic Attikon University Hospital 1, Rimini Str. 12462 Athens 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