Open versus minimally invasive hepatic and pancreatic surgery: 1-year costs, healthcare utilization and days of work lost.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2024-11-02 DOI:10.1016/j.hpb.2024.10.017

Muhammad M M Khan, Selamawit Woldesenbet, Muhammad M Munir, Mujtaba Khalil, Yutaka Endo, Erryk Katayama, Diamantis Tsilimigras, Zayed Rashid, Abdullah Altaf, Timothy M Pawlik

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Abstract

Background: Utilization of minimally invasive surgery (MIS) has become increasingly popular due to its potential benefits such as earlier recovery and reduced morbidity. We sought to characterize differences in 1-year healthcare costs and missed workdays among patients undergoing MIS and open surgery for a hepatic or pancreatic indication.

Methods: Data on patients who underwent hepatic and pancreatic resection were obtained from the IBM Marketscan database. Generalized linear models were utilized to compare healthcare costs and missed workdays among patients undergoing MIS versus open surgery.

Results: Among 8705 patients, 85.0 % (n = 7399) and 15.0 % (n = 1306) of patients underwent an open or MIS HP procedure, respectively. In the unmatched cohort, patients who underwent MIS were more likely to be female (62.7 % vs. 54.6 %) and were less likely to have a Charlson Comorbidity Index score >2 (34.5 % vs. 49.6 %) (both p < 0.05). After entropy balancing, multivariable analysis demonstrated that MIS was associated with lower 1-year post discharge expenditures (mean difference -$9,739, 95%CI-$12,893, -$6585) and fewer missed workdays at 1-year post-discharge (IRR 0.84, 95%CI 0.81-0.87) (all p < 0.001).

Conclusion: At index hospitalization and 1-year post-discharge, an HP MIS approach was associated with lower healthcare expenditures versus open surgery for hepatic and pancreatic resection, as well as fewer missed workdays.

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开放式与微创肝脏和胰腺手术：1年成本、医疗保健利用率和误工天数。

背景：由于微创手术（MIS）具有提前康复和降低发病率等潜在优势，因此越来越受到人们的青睐。我们试图描述因肝脏或胰腺适应症而接受微创手术和开放手术的患者在 1 年医疗费用和误工天数方面的差异：方法：我们从 IBM Marketscan 数据库中获取了接受肝脏和胰腺切除术的患者数据。利用广义线性模型比较了接受 MIS 与开放手术患者的医疗费用和误工天数：在8705名患者中，分别有85.0%（n = 7399）和15.0%（n = 1306）的患者接受了开放式或MIS HP手术。在非配对队列中，接受 MIS 手术的患者中女性比例更高（62.7% 对 54.6%），Charlson 综合征指数评分大于 2 分的比例更低（34.5% 对 49.6%）（均为 p 结论：接受 MIS 手术的患者中女性比例更高（62.7% 对 54.6%），Charlson 综合征指数评分大于 2 分的比例更低（34.5% 对 49.6%）：在指数住院和出院 1 年后，采用 HP MIS 方法进行肝脏和胰腺切除术与开放手术相比，医疗支出更低，误工天数更少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).