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 - Funding Information:
No grant support was obtained or used for this study. This study was funded internally by Mayo Clinic, Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, and Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
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
VL - 163
SP - 495
EP - 502
JO - Surgery (United States)
JF - Surgery (United States)
SN - 0039-6060
IS - 3
ER -