TY - JOUR
T1 - Implementation of prospective, surgeon-driven, risk-based pathway for pancreatoduodenectomy results in improved clinical outcomes and first year cost savings of $1 million
AU - Shubert, Christopher R.
AU - Kendrick, Michael L.
AU - Habermann, Elizabeth B.
AU - Glasgow, Amy E.
AU - Borah, Bijan J.
AU - Moriarty, James P.
AU - Cleary, Sean P.
AU - Smoot, Rory L.
AU - Farnell, Michael B.
AU - Nagorney, David M.
AU - Truty, Mark J.
AU - Que, Florencia G.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/3
Y1 - 2018/3
N2 - Background: Morbidity and costs after pancreatoduodenectomy remain increased, driven by postoperative pancreatic fistula (POPF). A risk-based pathway for pancreatoduodenectomy (RBP-PD) was implemented and the clinical and cost outcomes compared with that of our historic practice. Methods: Prospective clinical and cost outcomes for our RBP-PD cohort treated from September 2014 to September 2015 were compared with a previously published cohort of pancreatoduodenectomies from January 2007 to February 2014. Results: A total of 128 RBP-PD cases were compared with 808 historic controls. Apart from less blood loss, there were no significant clinical differences between the 2 groups. Overall POPF rate did not change. Average duration of stay decreased to 10 days from 12 (P <.001) despite similar readmission rates. Postsurgical interventional radiology procedures decreased to 18.0% from 26.4% (P =.048). Utilization of and duration of stay in monitored care decreased to 23.4% from 35.6% (P <.01) and to 1 day from 3 (P <.01). On multivariable analysis RBP-PD was independently associated with decreased odds of higher postoperative pancreatic fistula grade, monitored care, and prolonged duration of stay. Inpatient cost of care decreased $6,387 per patient (–11.1%, P =.016), and total 30-day costs decreased $8,565 per patient (–13.7%, P =.01), representing a total 30-day cost savings of $1.1 million. Conclusion: RBP-PD significantly improved patient outcomes, decreased costs of care, and likely has applicability for surgical care beyond pancreatoduodenectomy.
AB - Background: Morbidity and costs after pancreatoduodenectomy remain increased, driven by postoperative pancreatic fistula (POPF). A risk-based pathway for pancreatoduodenectomy (RBP-PD) was implemented and the clinical and cost outcomes compared with that of our historic practice. Methods: Prospective clinical and cost outcomes for our RBP-PD cohort treated from September 2014 to September 2015 were compared with a previously published cohort of pancreatoduodenectomies from January 2007 to February 2014. Results: A total of 128 RBP-PD cases were compared with 808 historic controls. Apart from less blood loss, there were no significant clinical differences between the 2 groups. Overall POPF rate did not change. Average duration of stay decreased to 10 days from 12 (P <.001) despite similar readmission rates. Postsurgical interventional radiology procedures decreased to 18.0% from 26.4% (P =.048). Utilization of and duration of stay in monitored care decreased to 23.4% from 35.6% (P <.01) and to 1 day from 3 (P <.01). On multivariable analysis RBP-PD was independently associated with decreased odds of higher postoperative pancreatic fistula grade, monitored care, and prolonged duration of stay. Inpatient cost of care decreased $6,387 per patient (–11.1%, P =.016), and total 30-day costs decreased $8,565 per patient (–13.7%, P =.01), representing a total 30-day cost savings of $1.1 million. Conclusion: RBP-PD significantly improved patient outcomes, decreased costs of care, and likely has applicability for surgical care beyond pancreatoduodenectomy.
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U2 - 10.1016/j.surg.2017.10.022
DO - 10.1016/j.surg.2017.10.022
M3 - Article
C2 - 29275974
AN - SCOPUS:85038809457
SN - 0039-6060
VL - 163
SP - 495
EP - 502
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -