The laparoscopic approach to distal pancreatectomy is a value-added proposition for patients undergoing care in moderate-volume and high-volume centers

• Published in: Surgery Vol. 166; no. 2; pp. 166 - 171
• Main Authors: Eguia, Emanuel, Kuo, Paul C., Sweigert, Patrick, Nelson, Marc, Aranha, Gerard V., Abood, Gerard, Godellas, Constantine V., Baker, Marshall S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2019
• Subjects: Adult; Aged; Cohort Studies; Databases, Factual; Elective Surgical Procedures - economics; Elective Surgical Procedures - methods; Female; Health Care Costs; Hospitals, High-Volume; Humans; Laparoscopy - economics; Laparoscopy - methods; Length of Stay - economics; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness - pathology; Neoplasm Staging; Pancreatectomy - adverse effects; Pancreatectomy - methods; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Prognosis; Regression Analysis; Retrospective Studies; Survival Rate; Treatment Outcome; United States; United States
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2019.04.019

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. 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. 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. 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.