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Master of Public Health

Postoperative Global Period Cost Reduction Using 3 Successive Risk-Stratified Pancreatectomy Clinical Pathways

AUTHORS

Azimuddin A , Tzeng CD , Prakash LR , Bruno ML , Arvide EM , Dewhurst WL , Newhook TE , Kim MP , Ikoma N , Snyder RA , Lee JE , Perrier ND , Katz MH , Maxwell JE , . Journal of the American College of Surgeons. 2024 1 5; ().

ABSTRACT

BACKGROUND: We hypothesized that iterative revisions of our original 2016 risk-stratified pancreatectomy clinical pathways (RSPCPs) would be associated with decreased 90-day perioperative costs.

STUDY DESIGN: From a single-institution retrospective cohort study of consecutive patients with three iterations: “Version 1” (V1) (October 2016-January 2019), V2 (February 2019-October 2020), V3 (November 2020-February 2022), institutional data were aggregated using revenue codes and adjusted to constant 2022-dollar value. Grand total perioperative costs (primary endpoint) were the sum of pancreatectomy, inpatient care, readmission, and 90-day global outpatient care. Proprietary hospital-based costs were converted to ratios using the mean cost of all hospital operations as the denominator.

RESULTS: Of 814 patients, pathway V1 included 363, V2 229, and V3 222 patients. Accordion Grade 3+ complications decreased with each iteration (V1: 28.4%, V2: 22.7%, V3: 15.3%). Median stay decreased (V1: 6 days [IQR 5-8], V2: 5 [IQR 4-6], V3: 5 [IQR 4-6]) without an increase in readmissions.Ninety-day global perioperative costs decreased by 32% (V1 cost ratio 12.6, V2-10.9, V3-8.6). Reduction of the index hospitalization cost was associated with the greatest savings (-31%: 9.4, 8.34, 6.5). Outpatient care costs decreased consistently (1.58, 1.41, 1.04). When combining readmission and all outpatient costs, total “post-discharge” costs decreased (3.17, 2.59, 2.13).Component costs of the index hospitalization that were associated with the greatest savings were room/board costs (-55%: 1.74, 1.14, 0.79) and pharmacy costs (-61%: 2.20, 1.61, 0.87; all p<0.001).

CONCLUSIONS: Three iterative RSPCP refinements were associated with a 32% global-period cost savings, driven by reduced index hospitalization costs. This successful learning health system model could be externally validated at other institutions performing abdominal cancer surgery.

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