Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies

Background: Liver biopsy is an important tool in the management of patients with liver disease. Because 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, 3627 patients had 4275 liver biopsies (median 1 per patient; range 1-12). Radiologists performed the majority (90%), 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 most common. Six patients (0.14%) died; all had malignancies. The median direct cost of a hospitalization for complications was $4579 (range $1164-29 641). Conclusions: Liver biopsy rates are increasing likely owing 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 centres supports the safety of this important procedure.