What Drives High Costs of Cytoreductive Surgery and HIPEC: Patient, Provider or Tumor?

被引:15
作者
Schwartz, Patrick B. [1 ]
Stahl, Christopher C. [1 ]
Vande Walle, Kara A. [1 ]
Pokrzywa, Courtney J. [1 ]
Stafford, Linda M. Cherney [1 ]
Aiken, Taylor [1 ]
Barrett, James [1 ]
Acher, Alexandra W. [1 ]
Leverson, Glen [1 ]
Ronnekleiv-Kelly, Sean [1 ]
Weber, Sharon M. [1 ]
Abbott, Daniel E. [1 ]
机构
[1] Univ Wisconsin, Dept Surg, Sch Med & Publ Hlth, Div Surg Oncol, Madison, WI 53706 USA
基金
美国国家卫生研究院;
关键词
HIPEC; Cytoreductive; Cost; Resource; Peritoneal; HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY; PERITONEAL MALIGNANCY; COMPLICATIONS; EXPERIENCE; IMPACT;
D O I
10.1245/s10434-020-08583-7
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Introduction Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is utilized for peritoneal malignancies and is associated with significant resource use. To address potentially modifiable factors contributing to excessive cost, we sought to determine predictors of high cost of care for patients undergoing CRS/HIPEC. Methods An institutional CRS/HIPEC database was queried for adult patients from 2014 to 2018. Cost was defined as cost for the index hospitalization, and high-cost cases were defined as > 75th percentile for cost. Bivariate analyses for cost were performed, and all significant tumor, patient, and surgeon-specific variables were entered in a linear regression for cost. A separate linear regression was performed for length of stay (LOS). Results In total, 59 patients underwent 61 CRS/HIPEC procedures. The median direct variable cost was $20,509 (16,395-25,240). Median length of stay (LOS) was 8 (7-11.5) days and ICU stay was 1 (1-1.5) day. LOS, length of ICU stay and operative time were predictive of cost. Factors associated with increased LOS were Clavien-Dindo grade II complications and ostomy creation. Patient-related factors, including age and BMI, tumor-related factors, such as PCI and CCR, and surgeon were not predictive of cost nor LOS. Discussion Our results, the first to identify predictors of high cost of CRS/HIPEC-related care in the US, reveal cost was largely related to length and intensity of care. In turn, these drivers were influenced by complications and operative factors. Future work will focus on identifying an appropriate ERAS protocol following CRS/HIPEC and selection of those patients that may avoid routine ICU admission.
引用
收藏
页码:4920 / 4928
页数:9
相关论文
共 24 条
[1]   Trends in the indications for and short-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy [J].
Beal, Eliza W. ;
Ahmed, Ahmed ;
Grotz, Travis ;
Leiting, Jennifer ;
Fournier, Keith F. ;
Lee, Andrew J. ;
Dineen, Sean ;
Dessureault, Sophie ;
Baumgartner, Joel M. ;
Veerapong, Jula ;
Clarke, Callisia ;
Strong, Erin ;
Maithel, Shishir K. ;
Zaidi, Mohammad Y. ;
Patel, Sameer ;
Dhar, Vikrom ;
Hendrix, Ryan ;
Lambert, Laura ;
Johnston, Fabian ;
Fackche, Nadege ;
Raoof, Mustafa ;
LaRocca, Christopher ;
Ronnekleiv-Kelly, Sean ;
Pokrzywa, Courtney ;
Pawlik, Timothy M. ;
Abdel-Misih, Sherif ;
Cloyd, Jordan M. .
AMERICAN JOURNAL OF SURGERY, 2020, 219 (03) :478-483
[2]   The current practice of cytoreductive surgery and HIPEC for colorectal peritoneal metastases: Results of a worldwide web-based survey of the Peritoneal Surface Oncology Group International (PSOGI) [J].
Bushati, M. ;
Rovers, K. P. ;
Sommariva, A. ;
Sugarbaker, P. H. ;
Morris, D. L. ;
Yonemura, Y. ;
Quadros, C. A. ;
Somashekhar, S. P. ;
Ceelen, W. ;
Dube, P. ;
Li, Y. ;
Verwaal, V. J. ;
Glehen, O. ;
Piso, P. ;
Spiliotis, J. ;
Teo, M. C. C. ;
Gonzalez-Moreno, S. ;
Cashin, P. H. ;
Lehmann, K. ;
Deraco, M. ;
Moran, B. ;
de Hingh, I. H. J. T. .
EJSO, 2018, 44 (12) :1942-1948
[3]   Evaluation of the Cost-Effectiveness of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (Peritonectomy) at the St George Hospital Peritoneal Surface Malignancy Program [J].
Chua, Terence C. ;
Martin, Samantha ;
Cert, Grad ;
Saxena, Akshat ;
Liauw, Winston ;
Yan, Tristan D. ;
Zhao, Jing ;
Lok, Irene ;
Morris, David L. .
ANNALS OF SURGERY, 2010, 251 (02) :323-329
[4]   Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].
Dindo, D ;
Demartines, N ;
Clavien, PA .
ANNALS OF SURGERY, 2004, 240 (02) :205-213
[5]   Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States [J].
Dunn, Abe ;
Grosse, Scott D. ;
Zuvekas, Samuel H. .
HEALTH SERVICES RESEARCH, 2018, 53 (01) :175-196
[6]  
Eveno C, 2016, PLEURA PERITONEUM, V1, P169, DOI [10.1515/pap-2016-0027, 10.1515/pp-2016-0027]
[7]   When to use and how to report the results of PLS-SEM [J].
Hair, Joseph F. ;
Risher, Jeffrey J. ;
Sarstedt, Marko ;
Ringle, Christian M. .
EUROPEAN BUSINESS REVIEW, 2019, 31 (01) :2-24
[8]   Cytoreduction with hyperthermic intraperitoneal chemotherapy: an appraisal of outcomes and cost at a newly established peritoneal malignancy program [J].
Hinkle, Nathan M. ;
MacDonald, James ;
Sharpe, John P. ;
Dickson, Paxton ;
Deneve, Jeremiah ;
Munene, Gitonga .
AMERICAN JOURNAL OF SURGERY, 2016, 212 (03) :413-418
[9]   Factors Associated with 60-Day Readmission Following Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy [J].
Kelly, Kaitlyn J. ;
Cajas, Luis ;
Baumgartner, Joel M. ;
Lowy, Andrew M. .
ANNALS OF SURGICAL ONCOLOGY, 2018, 25 (01) :91-97
[10]   Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a US HIPEC Collaborative Study [J].
Lee, Tiffany C. ;
Wima, Koffi ;
Sussman, Jeffrey J. ;
Ahmad, Syed A. ;
Cloyd, Jordan M. ;
Ahmed, Ahmed ;
Fournier, Keith ;
Lee, Andrew J. ;
Dineen, Sean ;
Powers, Benjamin ;
Veerapong, Jula ;
Baumgartner, Joel M. ;
Clarke, Callisia ;
Mogal, Harveshp ;
Zaidi, Mohammad Y. ;
Maithel, Shishir K. ;
Leiting, Jennifer ;
Grotz, Travis ;
Lambert, Laura ;
Hendrix, Ryan J. ;
Abbott, Daniel E. ;
Pokrzywa, Courtney ;
Blakely, Andrew M. ;
Lee, Byrne ;
Johnston, Fabian M. ;
Greer, Jonathan ;
Patel, Sameer H. .
JOURNAL OF GASTROINTESTINAL SURGERY, 2020, 24 (01) :165-176