Top

Journal of Gastrointestinal Surgery

Published in:

01-06-2019 | Original Article

Identifying Hospital Cost Savings Opportunities by Optimizing Surgical Approach for Distal Pancreatectomy

Authors: Dimitrios Xourafas, Jordan M. Cloyd, Thomas E. Clancy, Timothy M. Pawlik, Stanley W. Ashley

Published in: Journal of Gastrointestinal Surgery | Issue 6/2019

Abstract

Background

The economic implications of relevant clinicopathologic factors on the surgical approach to distal pancreatectomy (DP) should be clearly defined and understood to potentially allow the implementation of cost reduction strategies.

Methods

Administrative and clinical datasets of patients undergoing a DP between 2012 and 2016 were merged and queried. Univariate and multivariate analyses were used to identify clinicopathologic predictors of cost differentials for minimally invasive DP (MIDP) relative to open DP (ODP). Time trends in cost were also assessed to identify opportunities for cost containment.

Results

Among two hundred and twenty five patients, 128 underwent an ODP (57%) and 97 a MIDP (43%). The DP groups were comparable with regard to relevant perioperative and disease characteristics. Total hospitalization and total OR costs for MIDP were significantly lower (− 12%, P = 0.0048) and higher (+ 16%, P < 0.0001) respectively, compared to ODP. On univariate analysis, age > 60 (− 12%, P = 0.0262), BMI > 25 (− 10%, P = 0.0222), ASA class ≥ 3 (− 11%, P = 0.0045), OpTime > 230 min (− 16%, P = 0.0004), and T stage ≥ 3 (− 8%, P = 0.0452) were associated with decreased total costs after MIDP compared to ODP. Linear regression analysis revealed that BMI > 25 (Estimate − 0.31, SE 0.15, P = 0.0482), ASA class ≥ 3 (Estimate − 0.36, SE 0.17, P = 0.0344), and T stage ≥ 3 (Estimate − 0.57, SE 0.26, P = 0.0320) were associated with decreased hospitalization costs after MIDP compared to ODP. Overtime, total hospitalization cost for MIDP increased from − 21 to 1% (P = 0.0197), while OR costs for MIDP decreased from + 41% to − 2% (P = 0.0049), nearly equalizing the cost differences between ODP and MIDP.

Conclusions

Relevant clinicopathologic factors predicted decreased hospitalization costs after MIDP relative to ODP. In equivalent stages of disease, optimizing the surgical approach to DP based on specific clinicopathologic characteristics may afford significant cost-saving opportunities.

Vollmer CM, Pratt W, Vanounou T, Maithel SK, Callery MP. Quality assessment in high-acuity surgery: volume and mortality are not enough. Arch Surg 2007;142(4):371–80.CrossRefPubMed

Kennedy EP, Rosato EL, Sauter PK, Rosenberg LM, Doria C, Marino IR, Chojnacki KA, Berger AC, Yeo CJ. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution–the first step in multidisciplinary team building. J Am Coll Surg 2007;204(5):917–23.CrossRefPubMed

Vanounou T, Pratt W, Fischer JE, Vollmer CM, Callery MP. Deviation-based cost modeling: a novel model to evaluate the clinical and economic impact of clinical pathways. J AmColl Surg 2007;204:570–9.

Kooby, Gillespie, Bentrem, Nakeeb, Schmidt, Merchant, . . . Hawkins. (2008). Left-sided Pancreatectomy: A Multicenter Comparison of Laparoscopic and Open Approaches. Annals of Surgery, 248(3), 438–446.

Kooby, Hawkins, Schmidt, Weber, Bentrem, Gillespie, . . . Lillemoe. (2010). A Multicenter Analysis of Distal Pancreatectomy for Adenocarcinoma: Is Laparoscopic Resection Appropriate?. Journal of the American College of Surgeons, 210(5), 779–785.

Venkat REB, Schulick RD, Lidor AO, Makary MA, Wolfgang CL. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 2012; 255:1048–1059.CrossRefPubMed

Nigri, Rosman, Petrucciani, Fancellu, Pisano, Zorcolo, & Melis (2010). Meta-Analysis of Trials Comparing Minimally-Invasive and Open Distal Pancreatectomy. Journal of Surgical Research, 158(2), 383.CrossRef

Jin, T., Altaf, K., Xiong, J., Huang, W., Javed, M., Mai, G., . . . Xia, Q. (2012). A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB, 14(11), 711–724.

Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 2012; 26:904–913.CrossRefPubMed

10.

Xourafas D, Tavakkoli A, Clancy TE, Ashley SW. Distal pancreatic resection for neuroendocrine tumors: Is laparoscopic really better than open?. J Gastrointest Surg 2015; 19(5):831–840.CrossRefPubMedPubMedCentral

11.

Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D. Safety, efficacy, and cost-effectiveness of common laparoscopic procedures. Surg Endosc 2011; 25:1127–1135.CrossRefPubMed

12.

Limongelli, Paolo, Belli, Andrea, Russo, Gianluca, Cioffi, Luigi, D’Agostino, Alberto, Fantini, Corrado, & Belli, Giulio. (2012). Laparoscopic and open surgical treatment of left-sided pancreatic lesions: Clinical outcomes and cost-effectiveness analysis. Surgical Endoscopy, 26(7), 1830–1836.CrossRefPubMed

13.

Abu Hilal M, Hamdan M, Di Fabio F, Pearce NW, Johnson CD. Laparoscopic versus open distal pancreatectomy: a clinical and costeffectiveness study. Surg Endosc 2012; 26:1670–1674.CrossRefPubMed

14.

Fox, A., Pitzul, M., Bhojani, K., Kaplan, F., Moulton, M., Wei, C., . . . Okrainec, I. (2012). Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center. Surgical Endoscopy, 26(5), 1220–1230.

15.

Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc 2008; 22:1334–1338.CrossRefPubMed

16.

Waters, Canal, Wiebke, Dumas, Beane, Aguilar-Saavedra, . . . Schmidt. (2010). Robotic distal pancreatectomy: Cost effective?. Surgery, 148(4), 814–823.

17.

Rutz, D., Squires, M., Maithel, S., Sarmiento, J., Etra, J., Perez, S., . . . Kooby, D. (2014). Cost comparison analysis of open versus laparoscopic distal pancreatectomy. HPB, 16(10), 907–914.

18.

Chen, Hai-Ning, Chen, Xin-Zu, Zhang, Wei-Han, Yang, Kun, Chen, Xiao-Long, Zhang, Bo, . . . Hu, Jian-Kun. (2015). The Impact of Body Mass Index on the Surgical Outcomes of Patients With Gastric Cancer: A 10-Year, Single-Institution Cohort Study. Medicine,94(42), E1769.

19.

Sabzi F, Faraji R. Effect of Body Mass Index on Postoperative Complications in Beating Coronary Artery Surgery. Ethiopian Journal of Health Sciences. 2016;26(6):509–516.CrossRefPubMedPubMedCentral

20.

S S Zhang, H Yang, K J Luo, Q Y Huang, J Y Chen, F Yang, J H Fu. (2013). The impact of body mass index on complication and survival in resected esophageal cancer: A clinical-based cohort and meta-analysis. British Journal of Cancer,109(11), 2894–2903.CrossRefPubMedPubMedCentral

21.

Damania R, Cocieru A. Impact of enhanced recovery after surgery protocols on postoperative morbidity and mortality in patients undergoing routine hepatectomy: review of the current evidence. Annals of Translational Medicine. 2017;5(17):341.CrossRefPubMedPubMedCentral

22.

Partelli, Crippa, Castagnani, Ruffo, Marmorale, Franconi, . . . Falconi. (2016). Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients. HPB, 18(2), 153–158.

23.

Kagedan, D., Ahmed, M., Devitt, K., & Wei, A. (2015). Enhanced recovery after pancreatic surgery: A systematic review of the evidence. HPB, 17(1), 11–16.CrossRefPubMed

24.

Intuitive SIW, the Free Encyclopedia. [Last accessed on 2015 Sep 10]. Available from: http://www.enwikipedia.org/wiki/Intuitive_Surgical.

25.

Peter Van Dam, Jan Hauspy, Luc Verkinderen, Xuan Bich Trinh, Pieter-Jan Van Dam, Luc Van Looy, & Luc Dirix. (2011). Are Costs of Robot-Assisted Surgery Warranted for Gynecological Procedures?. Obstetrics and Gynecology International, 2011(2011), 103–108.

26.

Heemskerk J, Bouvy ND, Baeten CG. The end of robot-assisted laparoscopy? A critical appraisal of scientific evidence on the use of robot-assisted laparoscopic surgery. Surg Endosc. 2014;28:1388–98.CrossRefPubMed

27.

Albani JM, Lee DI. Virtual reality-assisted robotic surgery simulation. J Endourol. 2007;21:285–7.CrossRefPubMed

28.

Iavazzo C, Papadopoulou EK, Gkegkes ID. Cost assessment of robotics in gynecologic surgery: A systematic review. J Obstet Gynaecol Res. 2014;40:2125–34.CrossRefPubMed

Title: Identifying Hospital Cost Savings Opportunities by Optimizing Surgical Approach for Distal Pancreatectomy
Authors: Dimitrios Xourafas
Jordan M. Cloyd
Thomas E. Clancy
Timothy M. Pawlik
Stanley W. Ashley
Publication date: 01-06-2019
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 6/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-4002-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Identifying Hospital Cost Savings Opportunities by Optimizing Surgical Approach for Distal Pancreatectomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2019

Immunosuppressed Patients with Crohn’s Disease Are at Increased Risk of Postoperative Complications: Results from the ACS-NSQIP Database

Endoscopic Submucosal Dissection for Esophageal Adenocarcinoma: A North American Perspective

Response to Letter to Editor: Advances in Endoscopic Techniques for Resection of Duodenal Neuroendocrine Tumours Response to: Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature

Facility Variation in Local Staging of Rectal Adenocarcinoma and its Contribution to Underutilization of Neoadjuvant Therapy

Retrospective Study of Cystic Echinococcosis in a Recent Cohort of a Referral Center for Liver Surgery

The 5-HT4 Receptor Agonist Prucalopride Stimulates Mucosal Growth and Enhances Carbohydrate Absorption in the Ileum of the Mouse