A Policy of Omitting an ICU Stay Following Robotic Pancreaticoduodenectomy is Safe and Cost Effective

Abstract Background Immediate post-operative admission to the ICU following pancreaticoduodenectomy (PD) is still standard practice at many institutions. Our aim was to examine if omission of an immediate post-operative ICU admission would be safe and result in improved outcomes and cost following robotic pancreaticoduodenectomy (RPD). Methods In December 2014, a non-ICU admission policy was implemented for patients undergoing RPD. Prior to this date, all RPDs were routinely admitted to the ICU on POD=0. Using a prospective database, outcomes of the No-ICU cohort were compared to patients routinely admitted to the ICU prior to implementation of this policy. Results The ICU (n=49) and No-ICU cohorts (n=47) were comparable in age, sex, BMI, CCI and ASA scores, receipt of neoadjuvant therapy, operative time, estimated blood loss, tumor size, and pathologic diagnosis (all P=NS). Clavien complications, pancreatic leak, reoperation, readmission, and mortality were similar between both groups (all P=NS). Hospital length of stay was shorter for the No-ICU group (median 6.8 versus 7.7 days, P=0.01). This reduced LOS and omission of routine post-operative ICU admission translated into a cost reduction from $23,933 (IQR $19,833 - $28,991) in the ICU group to $19,516 (IQR $17,046 - $23,893) in the No-ICU group, P=0.004. The reduction in LOS and cost remained significant after adjusting for all related demographics and perioperative characteristics. Conclusions A standard policy of omitting a postoperative ICU admission on POD0 following RPD is safe and can result in reduced length of stay and overall savings in total hospital cost.