Relative Incremental Cost of Postoperative Complications of Esophagectomy

Geller, Abraham D.; Gaissert, Henning A.; Mathisen, Douglas J.; Muniappan, Ashok; Wright, Cameron D.; Lanuti, Michael

doi:10.1053/j.semtcvs.2018.10.010

Cited by 16 publications

(11 citation statements)

References 28 publications

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“…In a retrospective study of over 700 esophagectomies by Geller et al, 14 the authors reported a 76% increased incremental cost per major post-operative complication following esophagectomy, regardless of surgical approach. The most significant post-operative complication leading to a 200% increase in incremental cost per event was due to anastomotic complications requiring re-operation.…”

Section: Discussionmentioning

confidence: 99%

“…The most significant post-operative complication leading to a 200% increase in incremental cost per event was due to anastomotic complications requiring re-operation. 14 Another retrospective study, utilizing the Surveillance, Epidemiology, and End-Results-Medicare database for esophagectomy cost, showed 90-day median cost in patients having a post-operative complication. Complications were predicted by women undergoing a transthoracic approach for mid esophageal stage I or III+ squamous cell carcinoma without receiving neoadjuvant treatment.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Cost for Robotic vs “Non-Robotic” Transhiatal Esophagectomy

Ross

Rayman

Thomas

et al. 2021

The American Surgeon

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Introduction This study was undertaken to analyze and compare the cost of robotic transhiatal esophagectomy (THE) to “non-robotic” THE (ie, “open” and laparoscopic). Methods With IRB approval, we prospectively followed 82 patients who underwent THE. We analyzed clinical outcomes and perioperative charges and costs associated with THE. To compare profitability, the robotic approach was analyzed against “non-robotic” approaches of THE using F-test, Mann-Whitney U test/Student’s t-test, and Fisher’s exact test. Statistical significance was reported as P ≤0.05. Data are presented as median (mean ± SD). Results 67 patients underwent the robotic approach, and 15 patients underwent “non-robotic” approach; 4 were “open” and 11 were laparoscopic. 79 patients had adenocarcinoma. Operative duration for robotic THE was 327 (331 ± 82.8) vs 213 (225 ± 62.0) minutes ( P = 0.0001) and estimated blood loss was 150 (184 ± 136.1) vs 300 (476 ± 708.7) mL ( P = 0.0001). Length of stay was 7 (11 ± 11.8) vs 8 (12 ± 10.6) days ( P = 0.76). 16 patients had post-operative complications with a Clavien-Dindo score of three or more. Hospital charges for robotic THE were $197,405 ($259,936 ± 203,630.8) vs “non-robotic” THE $159,588 ($201,565 ± $185,763.5) ( P = 0.31). Cost of care for robotic THE was $34,822 ($48,844 ± $45,832.8) vs “non-robotic” THE was $23,939 ($39,386 ± $44,827.2) ( P = 0.47). Payment received for robotic THE was $14,365 ($30,003 ± $40,874.7) vs “non-robotic” THE was $28,080 ($41,087 ± $44,509.1) ( P = 0.41). 15% of robotic operations were profitable vs 13% of “non-robotic” operations. Conclusions Patients were predominantly older overweight men who had adenocarcinoma of the esophagus. The robotic approach had increased operative time and minimal blood loss. More than a fourth of operations included concomitant procedures. Patients were discharged approximately one week after THE. Overall, the robotic approach has no apparent significant differences in charges, cost, or profitability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluating the Cost for Robotic vs “Non-Robotic” Transhiatal Esophagectomy

Ross

Rayman

Thomas

et al. 2021

The American Surgeon

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“…Direct and indirect cost percentages as a function of total hospital costs were evaluated in patients that underwent a reoperation compared with those that did not undergo a reoperation. Prior studies evaluating costs associated with reoperations were performed in samples where the majority of patients underwent open esophagectomies 23,24. A recent study of only minimally invasive esophagectomies found that reoperations were a driver of postoperative costs 25.…”

Section: Discussionmentioning

confidence: 99%

Reoperative Surgery After Minimally Invasive Ivor Lewis Esophagectomy

Pather¹,

Ghannam²,

Hacker³

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Objective: The aim of this study is to identify factors influencing reoperations following minimally invasive Ivor Lewis esophagectomy and associated mortality and hospital costs.Materials and Methods: Between 2013 and 2018, 125 patients were retrospectively analyzed. Outcomes included reoperations, mortality, and hospital costs. Multivariable logistic regression analyses determined factors associated with reoperations.Results: In-hospital reoperations (n = 10) were associated with inhospital mortality (n = 3, P < 0.01), higher hospital costs (P < 0.01), and longer hospital stay (P < 0.01). Conversely, reoperations after discharge were not associated with mortality. By multivariable analysis, baseline cardiovascular (P = 0.02) and chronic kidney disease (P = 0.01) were associated with reoperations. However, anastomotic leaks were not associated with reoperations nor mortality. Conclusion:The majority of reoperations occur within 30 days often during index hospitalization. Reoperations were associated with increased in-hospital mortality and hospital costs. Notably, anastomotic leaks did not influence reoperations nor mortality. Efforts to optimize patient baseline comorbidities should be emphasized to minimize reoperations following minimally invasive Ivor Lewis esophagectomy.

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“…We are not aware of a rigorous comparison of economic considerations between conventional MIE, RAMIE, and open esophagectomy but anticipate publications comparing relevant cost matrices over the next 1 to 2 years. Given that 90-day hospital costs of esophagectomy are increased 40% by complications, 24 it is feasible to hypothesize that the lower rates of complications from MIE demonstrated in TIME, MIRO, and ROBOT could mitigate, to some extent, the costs of MIE.…”

Section: Conventional Mie Versus Ramiementioning

confidence: 99%