Abstract
Background
Little is known regarding the impact of the minimally invasive approach to distal
pancreatectomy on the aggregate costs of care for patients undergoing distal pancreatectomy.
Methods
We queried the Healthcare Cost and Utilization Project State Inpatient Database to
identify patients undergoing elective laparoscopic distal pancreatectomy or open distal
pancreatectomy between 2012 and 2014. Multivariable regression was used to evaluate
postoperative outcomes including readmissions to 90 days after distal pancreatectomy.
Results
A total of 267 (11%) patients underwent laparoscopic distal pancreatectomy, and a
total of 2,214 (89%) underwent open distal pancreatectomy. On multivariable regression,
patients undergoing laparoscopic distal pancreatectomy had a decreased odds risk of
having any severe adverse outcome (odds ratio 0.73, 95% confidence interval [0.54–0.97]),
prolonged length of stay (odds ratio 0.49, 95% confidence interval [0.30–0.79]), and
of being in the highest quartile for aggregate costs of care (odds ratio 0.46, 95%
confidence interval [0.32–0.66]) relative to those undergoing open distal pancreatectomy.
Patients undergoing laparoscopic distal pancreatectomy had a lower average 90-day
aggregate cost of care than those undergoing open distal pancreatectomy when procedures
were performed in high-volume (–$16,153, 95% CI: [–$23,342 to –$8,964]) centers.
Conclusion
Patients undergoing laparoscopic distal pancreatectomy have a lower risk of severe
adverse outcomes, prolonged overall length of stay, and lower associated costs of
care relative to those undergoing open distal pancreatectomy. This association is
independent of hospital volume.
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Article info
Publication history
Published online: May 31, 2019
Accepted:
April 24,
2019
Footnotes
Supported by the National Institutes of Health 5 T32 GM008750-18 (EE)
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
