Improved Quality of Care and Efficiency Do Not Always Mean Cost Recovery After Minimally Invasive Ivor Lewis Esophagectomy

Pather, Keouna; Ravindran, Krishnan; Guerrier, Christina; Esma, Rhemar; Kendall, Heather; Hacker, Shoshana; Awad, Ziad T.

doi:10.1007/s11605-021-04931-4

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…Our institution qualifies as a regional safety-net facility with a high proportion of Medicare and Medicaid-insured patients undergoing complex surgeries [ 19 ]. In contrast to prior reports, our study demonstrated that postoperative complications following pancreaticoduodenectomy procedures in Black/AA patients at our safety-net hospital were comparable to a matched national cohort [ 6 , 11 , 13 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Whipple Outcomes Between a Safety-Net Hospital and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in African Americans

Pather,

Mobley,

Alabbas

et al. 2023

Cureus

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Purpose The aim of this study was to compare 30-day adverse events following pancreaticoduodenectomy between our safety-net hospital and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in a matched cohort of Black/African American (AA) patients. Methods We retrospectively reviewed consecutive Black/AA patients undergoing pancreaticoduodenectomies from 2015 to 2020 at our safety-net institution. The corresponding patients from the ACS-NSQIP (2015-2019) were queried. Propensity-score matching was performed between safety-net and ACS-NSQIP Black/AA cohorts to equate baseline characteristics, and 30-day outcomes were compared between propensity-matched cohorts. Results Thirty-two Black/AAs (16 females; 62.1±10.7 years) were identified from 128 patients undergoing pancreaticoduodenectomies at our safety-net institution and were propensity-score matched to 32 ACS-NSQIP patients. After matching, baseline characteristics did not significantly differ between cohorts. Postoperatively, surgical site infections, wound disruptions, respiratory events, cardiovascular events, urinary tract infections, acute renal failure, sepsis, delayed gastric emptying, and pancreatic fistulas were not significantly different between our safety-net and ACS-NSQIP cohorts. Our length of stay (LOS) was longer (17.0(12.3-27.0) versus 10.0(7.0-16.0) days); however, patients with a LOS>30 days were comparable. Furthermore, 30-day readmissions were similar, and 30-day reoperations were lower (p=0.03) at our safety-net institution. Conclusions Black/AA patients who underwent pancreatectomies at a safety-net hospital had similar outcomes and fewer reoperations compared to a corresponding national cohort. Although we illustrate comparable outcomes, clinical pathways to mitigate and alleviate health disparities in marginalized populations at a safety-net hospital should be emphasized to continue improving outcomes.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Whipple Outcomes Between a Safety-Net Hospital and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in African Americans

Pather,

Mobley,

Alabbas

et al. 2023

Cureus

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“…The Vizient dataset has been used in a range of studies for evaluation of cost and outcome for several hospital based therapies. 19 –23…”

Section: Methodsmentioning

confidence: 99%

“…The Vizient dataset has been used in a range of studies for evaluation of cost and outcome for several hospital based therapies. [19][20][21][22][23] Vizient also calculates a severity-of-illness score for diagnosis related codes, which accounts for demographic variables, hospital diagnoses, and comorbid conditions that were present upon hospital admission. The database uses regression models to predict expected length of stay (LOS), mortality outcomes for all inpatient discharges in the database.…”

Section: Cost and Outcome Measuresmentioning

confidence: 99%

Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital

Aliyu

McGowan

Hussain

et al. 2021

J Intensive Care Med

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Objective: The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. Design: Retrospective cohort study Setting: 960 bed tertiary academic medical center Patients: Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. Interventions: Retrospective analysis of prevalence and outcomes. Measurements and Main Results: Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). Conclusion: Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.

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Long-term survival outcomes of esophageal cancer after minimally invasive Ivor Lewis esophagectomy

et al. 2022

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Objectives The aim of this study was to determine the long-term overall and disease-free survival and factors associated with overall survival in patients with esophageal cancer undergoing a totally minimally invasive Ivor Lewis esophagectomy (MILE) at a safety-net hospital. Methods This was a single-center retrospective review of consecutive patients who underwent MILE from September 2013 to November 2017. Overall and disease-free survival were analyzed by Kaplan-Meier estimates, and hazard ratios (HR) were derived from multivariable Cox regression models. Results Ninety-six patients underwent MILE during the study period. Overall survival at 1, 3, and 5 years was 83.2%, 61.9%, and 55.9%, respectively. Disease-free survival at 1, 3, and 5 years was 83.2%, 60.6%, and 47.5%, respectively. Overall survival (p < 0.001) and disease-free survival (p < 0.001) differed across pathological stages. By multivariable analysis, increasing age (HR, 1.06; p = 0.02), decreasing Karnofsky performance status score (HR, 0.94; p = 0.002), presence of stage IV disease (HR, 5.62; p = 0.002), locoregional recurrence (HR, 2.94; p = 0.03), and distant recurrence (HR, 4.78; p < 0.001) were negatively associated with overall survival. Overall survival significantly declined within 2 years and was independently associated with stage IV disease (HR, 3.29; p = 0.04) and distant recurrence (HR, 5.78; p < 0.001). Conclusion MILE offers favorable long-term overall and disease-free survival outcomes. Age, Karnofsky performance status score, stage IV, and disease recurrence are shown to be prognostic factors of overall survival. Prospective studies comparing long-term outcomes after different MIE approaches are warranted to validate survival outcomes after MILE.

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Improved Quality of Care and Efficiency Do Not Always Mean Cost Recovery After Minimally Invasive Ivor Lewis Esophagectomy

Cited by 3 publications

References 15 publications

A Comparison of Whipple Outcomes Between a Safety-Net Hospital and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in African Americans

A Comparison of Whipple Outcomes Between a Safety-Net Hospital and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in African Americans

Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital

Long-term survival outcomes of esophageal cancer after minimally invasive Ivor Lewis esophagectomy

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