Simple SummaryLiver-directed treatments for hepatocellular carcinoma (HCC) have become a common form of therapy. We looked at data from the German Federal Statistical Office including all hospitalizations for HCC between 2010 and 2020 to see how these treatments were used and if age and gender played a role. We found that liver-directed therapies increased while there was a decrease in in-hospital stay and mortality. Minimally invasive treatments had lower mortality rates and shorter in-hospital stays than surgery. Women and older patients received fewer treatments, and mortality rates were higher for women. The findings suggest that there may be differences in the in-hospital care of these patients, and further investigation is needed.AbstractThis study analyzes nationwide trends in HCC hospitalizations focusing on interventional liver-directed treatments and the influence of age and gender. Using data from the German Federal Statistical Office all hospitalizations for HCC between 2010 and 2020 were included. Uni- and multivariable logistic regression analyses were performed to identify variables independently associated with the use of liver-directed therapies. Due to the COVID-19 pandemic, data from 2020 were analyzed separately. A total of 134,713 hospitalizations (2010–2019) were included, increasing by 3.4% annually (12,707 to 13,143). The mean in-hospital stay (−15.0% [7.2 to 6.1 days]) and mortality (−23.2% [6.8 to 5.2%]) decreased while transarterial, surgical, and percutaneous ablative interventions increased by 38.6, 31.5, and 19.3%, respectively. In-hospital mortality was 7.7% in admissions with surgical treatment, while it was 0.6 and 0.5% for transarterial and percutaneous interventions. Mortality was higher in females (6.2 vs. 5.7%). Females (OR 0.89 [0.86,0.91],p <0.001) and patients ≥80 years (OR 0.81 [0.79,0.84],p <0.001) were less likely to receive liver-directed treatments. Liver-directed therapies were increasingly performed while in-hospital mortality and in-hospital stay decreased. Minimally invasive approaches showed lower mortality, shorter in-hospital stay, and lower costs compared to surgery. Proportionately, more women and older patients were hospitalized, receiving fewer liver-directed treatments while their mortality was higher.