Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy
Objectives:. To assess both individual patient and institutional costs as well as outcomes in patients with pancreatic necrosis who underwent either endoscopic, minimal access or open pancreatic necrosectomy. These data can be used to evaluate clinical effectiveness with a view to informing local he...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2021-06-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000068 |
| _version_ | 1797732820260487168 |
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| author | Rebecca Saunders, MBChB Faye E. Hughes, BSc Jonathan C. Evans, MRCP, FRCR Howard L. Smart, DM, FRCP Paula Ghaneh, MD, FRCS Jayapal Ramesh, FRCR Robert Sutton, DPhil, FRCS Christopher M. Halloran, BSc, MD, FRCS, SFHEA |
| author_facet | Rebecca Saunders, MBChB Faye E. Hughes, BSc Jonathan C. Evans, MRCP, FRCR Howard L. Smart, DM, FRCP Paula Ghaneh, MD, FRCS Jayapal Ramesh, FRCR Robert Sutton, DPhil, FRCS Christopher M. Halloran, BSc, MD, FRCS, SFHEA |
| author_sort | Rebecca Saunders, MBChB |
| collection | DOAJ |
| description | Objectives:. To assess both individual patient and institutional costs as well as outcomes in patients with pancreatic necrosis who underwent either endoscopic, minimal access or open pancreatic necrosectomy. These data can be used to evaluate clinical effectiveness with a view to informing local healthcare providers.
Background:. Intervention for infected pancreatic necrosis is associated with a high morbidity, mortality, and long hospital stays. Minimal access surgical step-up approaches have been the gold standard of care; however, endoscopic approaches are now offered preferentially.
Methods:. All patients undergoing endoscopic (EN), minimal access retroperitoneal (MARPN), and open (OPN) necrosectomy at a single institution from April 2015 to March 2017 were included. Patients were selected for intervention based on morphology and position of the necrosis and on clinical factors. Patient-level costing systems were used to determine inpatient and outpatient costs.
Results:. Eighty-six patients were included: 38 underwent EN, 35 MARPN, and 13 OPN. Preoperative APACHEII was 6 versus 9 versus 9 (P = 0.017) and CRP 107 versus 204 versus 278 (P = 0.012), respectively. Postoperative stay was 19 days for EN versus 41 for MARPN versus 42 for OPN (P = 0.007). Complications occurred in 68.4%, 68.6%, and 46.2% (P = 0.298), whereas mortality was 10.5%, 22.9%, and 15.4% (P = 0.379), respectively. Mean total cost was £31,364 for EN, £52,770 for MARPN (P = 0.008), and £60,346 for OPN. Ward and critical care costs for EN were lower than for MARPN (ward: £9430 vs £14,033, P = 0.024; critical care: £5317 vs £16,648, P = 0.056).
Conclusions:. EN was at least as safe and effective as MARPN and OPN and was associated with markedly reduced hospital stay and cost, although some markers of disease severity were higher in patients undergoing MARPN and OPN. These results support EN as the preferred approach to necrosectomy, but hybrid utilization of all available techniques remains integral to optimal outcomes. |
| first_indexed | 2024-03-12T12:20:04Z |
| format | Article |
| id | doaj.art-dbf698e99a8a4ed18c67bc4da305342c |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:20:04Z |
| publishDate | 2021-06-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-dbf698e99a8a4ed18c67bc4da305342c2023-08-30T06:08:35ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932021-06-0122e06810.1097/AS9.0000000000000068202106000-00015Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic NecrosectomyRebecca Saunders, MBChB0Faye E. Hughes, BSc1Jonathan C. Evans, MRCP, FRCR2Howard L. Smart, DM, FRCP3Paula Ghaneh, MD, FRCS4Jayapal Ramesh, FRCR5Robert Sutton, DPhil, FRCS6Christopher M. Halloran, BSc, MD, FRCS, SFHEA7From the * Department of Molecular & Clinical Cancer Medicine, University of Liverpool, UK† Department of General & Pancreatic Surgery, Liverpool University Hospitals NHS Foundation Trust, UK‡ Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, UK§ Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, UK.From the * Department of Molecular & Clinical Cancer Medicine, University of Liverpool, UK§ Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, UK.From the * Department of Molecular & Clinical Cancer Medicine, University of Liverpool, UKFrom the * Department of Molecular & Clinical Cancer Medicine, University of Liverpool, UKObjectives:. To assess both individual patient and institutional costs as well as outcomes in patients with pancreatic necrosis who underwent either endoscopic, minimal access or open pancreatic necrosectomy. These data can be used to evaluate clinical effectiveness with a view to informing local healthcare providers. Background:. Intervention for infected pancreatic necrosis is associated with a high morbidity, mortality, and long hospital stays. Minimal access surgical step-up approaches have been the gold standard of care; however, endoscopic approaches are now offered preferentially. Methods:. All patients undergoing endoscopic (EN), minimal access retroperitoneal (MARPN), and open (OPN) necrosectomy at a single institution from April 2015 to March 2017 were included. Patients were selected for intervention based on morphology and position of the necrosis and on clinical factors. Patient-level costing systems were used to determine inpatient and outpatient costs. Results:. Eighty-six patients were included: 38 underwent EN, 35 MARPN, and 13 OPN. Preoperative APACHEII was 6 versus 9 versus 9 (P = 0.017) and CRP 107 versus 204 versus 278 (P = 0.012), respectively. Postoperative stay was 19 days for EN versus 41 for MARPN versus 42 for OPN (P = 0.007). Complications occurred in 68.4%, 68.6%, and 46.2% (P = 0.298), whereas mortality was 10.5%, 22.9%, and 15.4% (P = 0.379), respectively. Mean total cost was £31,364 for EN, £52,770 for MARPN (P = 0.008), and £60,346 for OPN. Ward and critical care costs for EN were lower than for MARPN (ward: £9430 vs £14,033, P = 0.024; critical care: £5317 vs £16,648, P = 0.056). Conclusions:. EN was at least as safe and effective as MARPN and OPN and was associated with markedly reduced hospital stay and cost, although some markers of disease severity were higher in patients undergoing MARPN and OPN. These results support EN as the preferred approach to necrosectomy, but hybrid utilization of all available techniques remains integral to optimal outcomes.http://journals.lww.com/10.1097/AS9.0000000000000068 |
| spellingShingle | Rebecca Saunders, MBChB Faye E. Hughes, BSc Jonathan C. Evans, MRCP, FRCR Howard L. Smart, DM, FRCP Paula Ghaneh, MD, FRCS Jayapal Ramesh, FRCR Robert Sutton, DPhil, FRCS Christopher M. Halloran, BSc, MD, FRCS, SFHEA Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy Annals of Surgery Open |
| title | Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy |
| title_full | Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy |
| title_fullStr | Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy |
| title_full_unstemmed | Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy |
| title_short | Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy |
| title_sort | cost analysis and outcomes of endoscopic minimal access and open pancreatic necrosectomy |
| url | http://journals.lww.com/10.1097/AS9.0000000000000068 |
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