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UTILIZATION RATES, COMPLICATIONS AND COSTS OF PERCUTANEOUS LIVER BIOPSY: A POPULATION-BASED STUDY INCLUDING 4,275 BIOPSIES
RP Myers1, A Fong2, AA Shaheen1
1Liver Unit, Division of Gastroenterology, Department of Medicine, University of Calgary; 2Health System Analysis Unit; Quality, Safety and Health Information, Calgary Health Region, Calgary, Alberta
BACKGROUND: Liver biopsy is an important tool in the management of patients with liver disease. Since biopsy practices may be changing, we studied patterns of use in a large Canadian health region. We aimed to describe trends in biopsy utilization and the incidence and costs of complications from a population-based perspective.
METHODS: Administrative databases were used to identify percutaneous liver biopsies performed between 1994 and 2002. Significant complications were identified by reviewing medical records of patients hospitalized within 7 days of a biopsy and those with a diagnostic code indicative of a procedural complication. Analyses of biopsy rates employed Poisson regression.
RESULTS: Between 1994 and 2002, 3,627 patients had 4,275 liver biopsies (median 1 per patient; range 1-12). Radiologists performed the majority (90%) of the biopsies, particularly during the latter years (1994 vs. 2002: 73% vs. 98%; P<0.0001). The overall annual biopsy rate was 54.8 per 100,000 population with a 41% (95% CI 23-61%) increase between 1994 and 2002. Annual increases were greatest in males and patients 30-59 years. Thirty-two patients (0.75%) had significant biopsy-related complications (1994-1997 vs. 1998-2002: 1.28% vs. 0.44%; P=0.003). Pain requiring admission (0.51%) and bleeding (0.35%) were the most common complications. Six patients (0.14%) died; all had malignancies. The median direct cost of a hospitalization for complications was $4,579 (range $1,164-29,641).
CONCLUSIONS: Liver biopsy rates are increasing likely due to the changing epidemiology and management of common liver diseases. The similarity of the complication rate in our population-based study with estimates from specialized centers supports the safety of this important procedure.