Implications and cost of pancreatic leak following distal pancreatic resection
Implications and cost of pancreatic leak following distal pancreatic resection
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DOI：
10.1001/archsurg.141.4.361
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发表时间：
2006-04-01
影响因子：
--
通讯作者：
Fernández-del Castillo, CFD
中科院分区：
文献类型：
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作者：
Rodríguez, JR;Germes, SS;Fernández-del Castillo, CFD
目的：选择性远端胰腺切除术后的胰残端漏（PL）会显着影响成本并增加随后的医疗资源利用率。我们试图为旨在减少其发生的潜在干预措施提供一个经济框架。设计：回顾性病例系列和经济评估。地点：大学附属的三级护理转诊中心。患者：66 名接受选择性远端胰腺切除术的患者。主要结果指标：术后并发症；医院和专业费用。结果：34 名患者 (52%) 发生总体术后并发症，无死亡。出现与 PL 直接相关并发症的患者总数为 22 例（33%）。无 PL 组的平均 +/- SD 总住院天数为 5.2 +/- 1.7 天（范围，3-12 天），而 PL 组则为 16.6 +/- 14.6 天（范围，4-49 天）（P=.001）。患有 PL 相关问题的患者的平均总费用是无 PL 组患者平均费用的 2.01 倍。为评估阈值成本而开发的决策分析模型表明，旨在将远端胰腺切除术并发症发生率降低三分之一的假设干预措施在经济上是合理的，每位患者的成本为 1418 美元。结论：远端胰腺切除术后 PL 引起的并发症使成本增加一倍，并显着提高医疗资源利用率。迫切需要制定减少这种常见并发症发生率的策略。旨在降低 PL 发生率的干预措施应考虑到这种成本差异。我们提供一个经济模型作为开发这些技术的指南。
Objectives: Pancreatic stump leak (PL) after elective distal pancreatic resection significantly impacts cost and increases subsequent health care resource utilization. We sought to provide an economic framework for potential interventions aimed at reducing its occurrence.Design: Retrospective case series and economic evaluation.Setting: University-affiliated, tertiary care referral center.Patients: Sixty-six patients undergoing elective distal pancreatectomy.Main Outcome Measures: Postoperative complications; hospital and professional costs.Results: Overall postoperative morbidity occurred in 34 patients (52%) with no deaths. The total number of patients with complications directly related to PL was 22 (33%). The meant +/- SD number of total hospital days for the no-PL group was 5.2 +/- 1.7 days (range, 3-12 days) vs 16.6 +/- 14.6 days (range, 4-49 days) for the PL group (P=.001). The average patient with PL-related problems incur-red a total cost that was 2.01 times greater than the average patient in the no-PL group. A decision analytic model developed to evaluate threshold costs showed that a hypothetical intervention designed to reduce the complication rate of distal pancreatectomy by one third would be financially justifiable up to a cost of $1418 per patient.Conclusions: Complications derived from PL following distal pancreatectomy double the cost and dramatically increase health care resource utilization. There is an urgent need to develop strategies that reduce the incidence of this common complication. Interventions aimed at decreasing the incidence of PL should take into account this cost differential. We provide an economic model to serve as a guide for developing these technologies.