Evidence map›Paper›PMID 30334179›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2019

Identifying Hospital Cost Savings Opportunities by Optimizing Surgical Approach for Distal Pancreatectomy.

Dimitrios Xourafas, Jordan M Cloyd, Thomas E Clancy, Timothy M Pawlik, Stanley W Ashley

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Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.

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5citing papers in PubMed, 2 pooled it
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Dimitrios XourafasDepartment of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA. dxourafas@bwh.harvard.edu.
Jordan M CloydDepartment of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Thomas E ClancyDepartment of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
Timothy M PawlikDepartment of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Stanley W AshleyDepartment of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe economic implications of relevant clinicopathologic factors on the surgical approach to distal pancreatectomy (DP) should be clearly defined and understood to potentially allow the implementation of cost reduction strategies.

methodsAdministrative and clinical datasets of patients undergoing a DP between 2012 and 2016 were merged and queried. Univariate and multivariate analyses were used to identify clinicopathologic predictors of cost differentials for minimally invasive DP (MIDP) relative to open DP (ODP). Time trends in cost were also assessed to identify opportunities for cost containment.

resultsAmong two hundred and twenty five patients, 128 underwent an ODP (57%) and 97 a MIDP (43%). The DP groups were comparable with regard to relevant perioperative and disease characteristics. Total hospitalization and total OR costs for MIDP were significantly lower (- 12%, P = 0.0048) and higher (+ 16%, P < 0.0001) respectively, compared to ODP. On univariate analysis, age > 60 (- 12%, P = 0.0262), BMI > 25 (- 10%, P = 0.0222), ASA class ≥ 3 (- 11%, P = 0.0045), OpTime > 230 min (- 16%, P = 0.0004), and T stage ≥ 3 (- 8%, P = 0.0452) were associated with decreased total costs after MIDP compared to ODP. Linear regression analysis revealed that BMI > 25 (Estimate - 0.31, SE 0.15, P = 0.0482), ASA class ≥ 3 (Estimate - 0.36, SE 0.17, P = 0.0344), and T stage ≥ 3 (Estimate - 0.57, SE 0.26, P = 0.0320) were associated with decreased hospitalization costs after MIDP compared to ODP. Overtime, total hospitalization cost for MIDP increased from - 21 to 1% (P = 0.0197), while OR costs for MIDP decreased from + 41% to - 2% (P = 0.0049), nearly equalizing the cost differences between ODP and MIDP.

conclusionsRelevant clinicopathologic factors predicted decreased hospitalization costs after MIDP relative to ODP. In equivalent stages of disease, optimizing the surgical approach to DP based on specific clinicopathologic characteristics may afford significant cost-saving opportunities.

Indexed as

Hospital CostsAgedCosts and Cost AnalysisFemaleHumansLaparoscopyMaleMiddle AgedNeoplasm StagingPancreatectomyPancreatic NeoplasmsRobotic Surgical ProceduresTreatment OutcomeClinicopathologic factorsCost savingsDistal pancreatic resectionLaparoscopicMinimally invasiveRoboticTotal hospitalization costs

Identifiers

PMID30334179

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.