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Cost-effective surgical management of liver disease in an university hospital: A retrospective study

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Published: Oct 10, 2022
DOI: https://doi.org/10.12681/healthresj.29409
Keywords:
Hepatobiliary surgery cost estimation cost-effective method adverse events
Ioanna Tseka
RN, MSc, PhD (c), National and Kapodistrian University of Athens, Medical School, Athens, Greece
https://orcid.org/0000-0003-1688-005X
Michael Chrisofos
Professor of Urology, 3rd Department of Urology, University General Hospital “ATTIKON”, National and University of Athens, Medical School, Athens, Greece.
Elissaios Kontis
MD, PhD, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
Christos Triantafyllou
RN, MSCE, PhD (c), Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
https://orcid.org/0000-0002-3198-3965
Panagiotis Kokoropoulos
MD, MSc, PhD (c), 4th Department of Surgery, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, Medical School, Athens, Greece
Nikolaos Arkadopoulos
Professor of Surgery, 4th Department of Surgery, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, Medical School, Athens, Greece
Abstract

Background: Hepatobiliary surgery is a high-end surgery comprising of complex operations associated with high economic burden to a healthcare system. The aim of this study was to evaluate the cost-effectiveness of a hepatobiliary surgery highly standardized operative protocol, that minimizes intraoperative and postoperative costs, implemented by the same surgical team, in a Greek university hospital for a five-year period (2012-2016).


Method and Material: The digital medical records of all patients undergoing liver resection at a tertiary university hospital from January 2012 to December 2016 by a single surgical team were retrospectively reviewed. The financial cost of the patients’ treatment was calculated in collaboration with the hospital’s logistics department, and it involved all preoperative, intraoperative, and postoperative expenses from admission to discharge, excluding physician fees and salary cost of the hospital’s nurses.


Results: In this study, 127 patients underwent hepatectomy. The patient’s health status was improved after the surgery in most of the cases (121, 95.2%). The mean Length of Stay (LOS) was 13.4 (SD±17.3) days. The mean total hospitalization cost was 4,729 (SD ± 5,486) euros (€), while the cost of surgery, the higher mean cost was noted in 2013 (925, SD±974.64 €) and the lower in 2015 (142, SD±219 €). 


Conclusions: This protocol allows the performance of hepatectomies with a significantly decreased cost without compromising patient outcomes.

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References
Marengo A, Rosso C, Bugianesi E. Liver Cancer: Connec-tions with Obesity, Fatty Liver, and Cirrhosis. Annu Rev Med 2016;67(1):103–17.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-386.
Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G. Comparative Short-term Benefits of Laparoscopic Liver Re-section: 9000 Cases and Climbing. Ann Surg 2016;263(4):761–77.
Ratti F, Cipriani F, Ariotti R, Gagliano A, Paganelli M, Catena M, et al. Safety and feasibility of laparoscopic liver resection with associated lymphadenectomy for intrahe-patic cholangiocarcinoma: a propensity score-based case-matched analysis from a single institution. Surg Endosc 2016;30(5):1999–2010.
Scuderi V, Barkhatov L, Montalti R, Ratti F, Cipriani F, Pardo F, et al. Outcome after laparoscopic and open resections of posterosuperior segments of the liver. Br J Surg 2017;104(6):751–9.
Bell R, Pandanaboyana S, Hanif F, Shah N, Hidalgo E, Lodge JPA, et al. A cost effective analysis of a laparoscopic versus an open left lateral sectionectomy in a liver trans-plant unit. HPB 2015;17(4):332–6.
Kawaguchi Y, Otsuka Y, Kaneko H, Nagai M, Nomura Y, Yamamoto M, et al. Comparisons of financial and short-term outcomes between laparoscopic and open hepatec-tomy: benefits for patients and hospitals. Surg Today 2016;46(5):535–42.
Stoot JHMB, van Dam RM, Coelen RJS, Winkens B, Olde Damink SWM, Bemelmans MHA, et al. The introduction of a laparoscopic liver surgery programme: a cost analysis of initial experience in a university hospital. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc 2012;101(1):32–7.
Arkadopoulos N, Gemenetzis G, Danias N, Kokoropoulos P, Koukopoulou I, Bartsokas C, et al. Cost-Effective Surgical Management of Liver Disease Amidst a Financial Crisis. World J Surg 2016;40(7):1695–701.
Arkadopoulos N, Gemenetzis G, Danias N, Kokoropoulos P, Koukopoulou I, Bartsokas C, et al. Cost-Effective Surgical Management of Liver Disease Amidst a Financial Crisis. World J Surg 2016;40(7):1695–701.
Sato M, Saku N, Takeda A, Suzuki N, Saito T, Minato N, et al. [A case report--pulmonary cryptococcosis associated with systemic lupus erythematosus and review of 44 cases in Japan]. Ryumachi Rheum 1993;33(1):56–62.
Doula C, Kostakis ID, Damaskos C, Machairas N, Vardakostas DV, Feretis T, et al. Comparison Between Min-imally Invasive and Open Pancreaticoduodenectomy: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2016;26(1):6–16.
Okunrintemi V, Gani F, Pawlik TM. National Trends in Postoperative Outcomes and Cost Comparing Minimally Invasive Versus Open Liver and Pancreatic Surgery. J Gas-trointest Surg Off J Soc Surg Aliment Tract 2016;20(11):1836–43.
Limongelli P, Vitiello C, Belli A, Pai M, Tolone S, Del Genio G, et al. Costs of laparoscopic and open liver and pancreat-ic resection: a systematic review. World J Gastroenterol 2014;20(46):17595–602.
Limongelli P, Vitiello C, Belli A, Pai M, Tolone S, Del Genio G, et al. Costs of laparoscopic and open liver and pancreat-ic resection: a systematic review. World J Gastroenterol 2014;20(46):17595–602.
Okunrintemi V, Gani F, Pawlik TM. National Trends in Postoperative Outcomes and Cost Comparing Minimally Invasive Versus Open Liver and Pancreatic Surgery. J Gas-trointest Surg Off J Soc Surg Aliment Tract 2016;20(11):1836–43.
Smyrniotis V, Arkadopoulos N, Kostopanagiotou G, Faran-tos C, Vassiliou J, Contis J, et al. Sharp liver transection ver-sus clamp crushing technique in liver resections: a pro-spective study. Surgery 2005;137(3):306–11.
Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg 2018;126(5):1763–8.
Di Saverio S, Catena F, Filicori F, Ansaloni L, Coccolini F, Keutgen XM, et al. Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing peri-hepatic packing: single institution 14 years experience at European trauma centre. Injury 2012;43(9):1347–54.
Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236(4):397–406; discus-sion 406-407.
Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer Oxf Engl 1990. 2001;37 Suppl 8:S4-66.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statis-tics, 2002. CA Cancer J Clin 2005;55(2):74–108.
Kenjo A, Miyata H, Gotoh M, Kitagawa Y, Shimada M, Baba H, et al. Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 2014;218(3):412–22.
Azagra JS, Goergen M, Gilbart E, Jacobs D. Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects. Surg Endosc 1996;10(7):758–61.
Hanly EJ, Talamini MA. Robotic abdominal surgery. Am J Surg 2004;188(4A Suppl):19S-26S.
Medbery RL, Chadid TS, Sweeney JF, Knechtle SJ, Kooby DA, Maithel SK, et al. Laparoscopic vs open right hepatec-tomy: a value-based analysis. J Am Coll Surg 2014;218(5):929–39.
Zhang X, Yang J, Yan L, Li B, Wen T, Xu M, et al. Compari-son of laparoscopy-assisted and open donor right hepa-tectomy: a prospective case-matched study from china. J Gastrointest Surg Off J Soc Surg Aliment Tract 2014;18(4):744–50.
Cipriani F, Ratti F, Cardella A, Catena M, Paganelli M, Al-drighetti L. Laparoscopic Versus Open Major Hepatecto-my: Analysis of Clinical Outcomes and Cost Effectiveness in a High-Volume Center. J Gastrointest Surg Off J Soc Surg Aliment Tract 2019;23(11):2163–73.
Cleary SP, Han H-S, Yamamoto M, Wakabayashi G, Asbun HJ. The comparative costs of laparoscopic and open liver resection: a report for the 2nd International Consensus Conference on Laparoscopic Liver Resection. Surg Endosc 2016;30(11):4691–6.
Peng J-X, Wang L-Z, Diao J-F, Tan Z-J, Zhong X-S, Zhen Z-P, et al. Major hepatectomy for primary hepatolithiasis: a comparative study of laparoscopic versus open treatment. Surg Endosc 2018;32(10):4271–6.
Cuschieri A, Ferreira E, Goh P, Idezuki Y, Maddern G, Marks G, et al. Guidelines for conducting economic outcomes studies for endoscopic procedures. Surg Endosc 1997;11(3):308–14.
Souliotis K, Golna C, Tountas Y, Siskou O, Kaitelidou D, Liaropoulos L. Informal payments in the Greek health sec-tor amid the financial crisis: old habits die last.. Eur J Health Econ HEPAC Health Econ Prev Care 2016;17(2):159–70.
Wilson CB. Adoption of new surgical technology. BMJ. 2006;332(7533):112–4.
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