Drivers of Cost for Pancreatic Surgery: It’s Not About Hospital Volume

Bateni, Sarah B.; Olson, Jennifer L.; Hoch, Jeffrey S.; Canter, Robert J.; Bold, Richard J.

doi:10.1245/s10434-018-6758-1

Cited by 20 publications

(28 citation statements)

References 36 publications

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“…Enomoto et al (45) added in an analysis of 3137 patients from the NIS database that the costs for patients treated by low-volume surgeons at LVCs are higher than those for patients treated by low-volume surgeons at HVCs. On the contrary, large retrospective series by Gani et al (32) (11,081 PR patients) and Bateni et al (21) (27,653 PR patients) found no significant association between costs and operation volume.…”

Section: Resultsmentioning

confidence: 88%

“…They stated that the OR for morbidity was 1.39–1.47 in low or medium volume centers compared with HVCs. Bateni et al (21) (27,653 patients) and Mehta et al (31) (2453 patients) analyzed the postoperative results of PRs and concluded that there were significantly more overall complications in LVCs than in HVCs. Mehta et al (31) added that surgeon volume is also an independent risk factor for 30-day complication rate.…”

Section: Resultsmentioning

confidence: 99%

“…However, Ahola et al (2) studying PD patients in a Finnish nationwide study and Stella et al (15) concentrating on PRs found no significant difference between volume groups in frequency of re-operations among PD patients. A large study by Bateni et al (21) comprising 27,653 patients undergoing PR revealed that re-admission is more common among patients operated on in LVCs than in HVCs. This was confirmed by Sutton et al (26) in a survey of 9805 PD patients.…”

Section: Resultsmentioning

confidence: 99%

“…This was confirmed by Sutton et al (26) in a survey of 9805 PD patients. Length of hospital stay was also analyzed in several studies resulting in the conclusion that hospital stay is shorter in HVCs than in LVCs (4, 16, 18, 21, 23–26, 29, 32, 39). In addition, Ahola et al (2) reported that hospital stay among Clavien-Dindo grade III patients was longer in LVCs than in HVCs.…”

Section: Resultsmentioning

confidence: 99%

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Centralization of Pancreatic Surgery Improves Results: Review

2020

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Background and Aims: The effect of operation volume on the outcomes of pancreatic surgery has been a subject of research since the 1990s. In several countries around the world, this has led to the centralization of pancreatic surgery. However, controversy persists as to the benefits of centralization and what the optimal operation volume for pancreatic surgery actually is. This review summarizes the data on the effect of centralization on mortality, complications, hospital facilities used, and costs regarding pancreatic surgery. Materials and Methods: A systematic librarian-assisted search was performed in PubMed covering the years from August 1999 to August 2019. All studies comparing results of open pancreatic resections from high- and low-volume centers were included. In total 44, published articles were analyzed. Results: Studies used a variety of different criteria for high-volume and low-volume centers, which hampers the evaluating of the effect of operation volume. However, mortality in high-volume centers is consistently reported to be lower than in low-volume centers. In addition, failure to rescue critically ill patients is more common in low-volume centers. Cost-effectiveness has also been evaluated in the literature. Length of hospital stay in particular has been reported to be shorter in high-volume centers than in low-volume centers. Conclusion: The effect of centralization on the outcomes of pancreatic surgery has been under active research and the beneficial effect of it is associated especially with better short-term prognosis after surgery.

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Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Centralization of Pancreatic Surgery Improves Results: Review

2020

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“…Patients transferred to the ICU also require special monitoring and intense care. Simultaneously, the number of complications greatly increased the in-hospital cost and length of hospitalization [ 6 ]. In a study of emergency department evaluation of suspected ICU patients, it was found that prolonged hospital stay in the emergency department increases the risk of death [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors and socio-economic burden in pancreatic ductal adenocarcinoma operation: a machine learning based analysis

et al. 2020

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Background Surgical resection is the major way to cure pancreatic ductal adenocarcinoma (PDAC). However, this operation is complex, and the peri-operative risk is high, making patients more likely to be admitted to the intensive care unit (ICU). Therefore, establishing a risk model that predicts admission to ICU is meaningful in preventing patients from post-operation deterioration and potentially reducing socio-economic burden. Methods We retrospectively collected 120 clinical features from 1242 PDAC patients, including demographic data, pre-operative and intra-operative blood tests, in-hospital duration, and ICU status. Machine learning pipelines, including Supporting Vector Machine (SVM), Logistic Regression, and Lasso Regression, were employed to choose an optimal model in predicting ICU admission. Ordinary least-squares regression (OLS) and Lasso Regression were adopted in the correlation analysis of post-operative bleeding, total in-hospital duration, and discharge costs. Results SVM model achieved higher performance than the other two models, resulted in an AU-ROC of 0.80. The features, such as age, duration of operation, monocyte count, and intra-operative partial arterial pressure of oxygen (PaO2), are risk factors in the ICU admission. The protective factors include RBC count, analgesic pump dexmedetomidine (DEX), and intra-operative maintenance of DEX. Basophil percentage, duration of the operation, and total infusion volume were risk variables for staying in ICU. The bilirubin, CA125, and pre-operative albumin were associated with the post-operative bleeding volume. The operation duration was the most important factor for discharge costs, while pre-lymphocyte percentage and the absolute count are responsible for less cost. Conclusions We observed that several new indicators such as DEX, monocyte count, basophil percentage, and intra-operative PaO2 showed a good predictive effect on the possibility of admission to ICU and duration of stay in ICU. This work provided an essential reference for indication in advance to PDAC operation.

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Defining Value for Pancreatic Surgery in Early-Stage Pancreatic Cancer

et al. 2019

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IMPORTANCE Value-based care is increasingly important, with rising health care costs and advances in cancer treatment leading to greater survival for patients with cancer. Regionalization of surgical care for pancreatic cancer has been extensively studied as a strategy to improve perioperative outcomes, but investigation of long-term outcomes relative to health care costs (ie, value) is lacking. OBJECTIVE To identify patient and hospital characteristics associated with improved overall survival, decreased costs, and greater value among patients with pancreatic cancer undergoing curative resection. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study identified 2786 patients with stages I to II pancreatic cancer who underwent pancreatic resection at 157 hospitals from January 1, 2004, through December 31, 2012. The study used the California Cancer Registry, which collects data from all California residents newly diagnosed with cancer, linked to the Office of Statewide Health Planning and Development database, which collects administrative data from all California licensed hospitals. Data were analyzed from November 11, 2017, through September 4, 2018.EXPOSURES Pancreatic resection at high-volume and/or National Cancer Institute (NCI)-designated cancer centers. MAIN OUTCOMES AND MEASURESThe primary outcomes were overall survival, surgical hospitalization costs, and value. High value was defined as the fourth quintile or higher for survival and the second quintile or less for costs. Costs were calculated from charges using cost-charge ratios and adjusted for geographic variation and inflation. Multivariable regression models were used to determine factors associated with overall survival, costs, and high value.RESULTS Among the 2786 patients included (1394 [50.0%] male; mean [SD] age, 67.0 [10.7] years), postoperative chemotherapy (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.64-0.79; P < .001) and high-volume centers (aHR, 0.78; 95% CI, 0.61-0.99; P = .04) were associated with greater overall survival. Higher Elixhauser comorbidity index scores (

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Drivers of Cost for Pancreatic Surgery: It’s Not About Hospital Volume

Cited by 20 publications

References 36 publications

Centralization of Pancreatic Surgery Improves Results: Review

Centralization of Pancreatic Surgery Improves Results: Review

Risk factors and socio-economic burden in pancreatic ductal adenocarcinoma operation: a machine learning based analysis

Defining Value for Pancreatic Surgery in Early-Stage Pancreatic Cancer

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