Cost analysis and outcomes of endoscopic, minimal access and open pancreatic necrosectomy.



Saunders, Rebecca, Hughes, Faye E, Evans, Jonathan C, Smart, Howard L, Ghaneh, Paula, Ramesh, Jayapal, Sutton, Robert and Halloran, Christopher M ORCID: 0000-0002-5471-4178
(2021) Cost analysis and outcomes of endoscopic, minimal access and open pancreatic necrosectomy. Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 2 (2).

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Abstract

<h4>Objectives</h4>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 health care providers.<h4>Summary background data</h4>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.<h4>Methods</h4>All patients undergoing endoscopic (EN), minimal access retroperitoneal (MARPN) and open (OPN) necrosectomy at a single institution from April 2015-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.<h4>Results</h4>86 patients were included: 38 underwent EN, 35 MARPN and 13 OPN. Pre-operative APACHEII was 6 vs 9 vs 9 (p=0.017) and CRP 107 vs 204 vs 278, (p=0.012), respectively. Post-operative stay was 19 days for EN vs. 41 for MARPN vs. 42 for OPN (p=0.007). Complications occurred in 68.4%, 68.6% and 46.2% (p=0.298) while 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: £9,430 vs. £14,033, p=0.024; critical care: £5,317 vs. £16,648, p=0.056).

Item Type: Article
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 23 Jun 2021 11:18
Last Modified: 02 Oct 2021 07:31
DOI: 10.1097/as9.0000000000000068
URI: https://livrepository.liverpool.ac.uk/id/eprint/3127432

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