The First Decade of Laparoscopic Pancreaticoduodenectomy in the United States: Costs and Outcomes Using the Nationwide Inpatient Sample
Background Minimally invasive pancreaticoduodenectomy (PD) remains an uncommon procedure, and the safety and efficacy remain uncertain beyond single institution case series. The aim of this study is to compare outcomes and costs between laparoscopic (LPD) and open PD (OPD) using a large population-b...
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| creator | Tran, Thuy B. Dua, Monica M. Worhunsky, David J. Poultsides, George A. Norton, Jeffrey A. Visser, Brendan C. |
| description | Background
Minimally invasive pancreaticoduodenectomy (PD) remains an uncommon procedure, and the safety and efficacy remain uncertain beyond single institution case series. The aim of this study is to compare outcomes and costs between laparoscopic (LPD) and open PD (OPD) using a large population-based database.
Methods
The Nationwide Inpatient Sample database (a sample of approximately 20 % of all hospital discharges) was analyzed to identify patients who underwent PD from 2000 to 2010. Patient demographics, comorbidities, hospital characteristics, inflation-adjusted total charges, and complications were evaluated using univariate and multivariate logistic regression. Hospitals were categorized as high-volume hospitals (HVH) if more than 20 PD (open and laparoscopic) were performed annually, while those performing fewer than 20 PD were classified as low-volume hospitals.
Results
Of the 15,574 PD identified, 681 cases were LPD (4.4 %). Compared to OPD, patients who underwent LPD were slightly older (65 vs. 67 years;
p
= 0.001) and were more commonly treated at HVH (56.6 vs. 66.1 %;
p
|
| doi_str_mv | 10.1007/s00464-015-4444-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1785735180</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1785735180</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-23f2845b4bdc3b6d0069b3e639e8e7914d4ba0e4b55a08807a4a50cf36f2c3083</originalsourceid><addsrcrecordid>eNp1kV1rFDEUhoModq3-AG8k4I03Y0--ZjLeyWq1sLRCu9chk5ypU3aScZJB9hf4t812q0jB3ISQ531PyEPIawbvGUBzlgBkLStgqpJlVfsnZMWk4BXnTD8lK2gFVLxp5Ql5kdIdFLxl6jk54TVvlJJ8RX7dfEd6Pswp00_orEcae7qxk51jcnEaHP1mg5vR5sFFv0SPAV2O454OgeaS3YYho6fX2WZMH-g6ppyoDZ5eLdnFERPdpiHc3rOXpSWGn0OZchGmcsCQ6bUdpx2-JM96u0v46mE_Jdvzzzfrr9Xm6svF-uOmclLoXHHRcy1VJzvvRFd7gLrtBNaiRY1Ny6SXnQWUnVIWtIbGSqvA9aLuuROgxSl5d-yd5vhjwZTNOCSHu50NGJdkWKNVIxTTUNC3j9C7uMyhvO5AyboREkSh2JFy5cfSjL2Z5mG0894wMAdL5mjJFEvmYMnsS-bNQ_PSjej_Jv5oKQA_AqlchVuc_xn939bftk2eJw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1784673403</pqid></control><display><type>article</type><title>The First Decade of Laparoscopic Pancreaticoduodenectomy in the United States: Costs and Outcomes Using the Nationwide Inpatient Sample</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Tran, Thuy B. ; Dua, Monica M. ; Worhunsky, David J. ; Poultsides, George A. ; Norton, Jeffrey A. ; Visser, Brendan C.</creator><creatorcontrib>Tran, Thuy B. ; Dua, Monica M. ; Worhunsky, David J. ; Poultsides, George A. ; Norton, Jeffrey A. ; Visser, Brendan C.</creatorcontrib><description>Background
Minimally invasive pancreaticoduodenectomy (PD) remains an uncommon procedure, and the safety and efficacy remain uncertain beyond single institution case series. The aim of this study is to compare outcomes and costs between laparoscopic (LPD) and open PD (OPD) using a large population-based database.
Methods
The Nationwide Inpatient Sample database (a sample of approximately 20 % of all hospital discharges) was analyzed to identify patients who underwent PD from 2000 to 2010. Patient demographics, comorbidities, hospital characteristics, inflation-adjusted total charges, and complications were evaluated using univariate and multivariate logistic regression. Hospitals were categorized as high-volume hospitals (HVH) if more than 20 PD (open and laparoscopic) were performed annually, while those performing fewer than 20 PD were classified as low-volume hospitals.
Results
Of the 15,574 PD identified, 681 cases were LPD (4.4 %). Compared to OPD, patients who underwent LPD were slightly older (65 vs. 67 years;
p
= 0.001) and were more commonly treated at HVH (56.6 vs. 66.1 %;
p
< 0.001). Higher rates of complications were observed in OPD than LPD (46 vs. 39.4 %;
p
= 0.001), though mortality rates were comparable (5 vs. 3.8 %,
p
= 0.27). Inflation-adjusted median hospital charges were similar between OPD and LPD ($87,577 vs. $81,833,
p
= 0.199). However, hospital stay was slightly longer in the OPD group compared to LPD group (12 vs. 11 days,
p
< 0.001). Stratifying outcomes by hospital volume, LPD at HVH resulted in shorter hospital stays (9 vs. 13 days,
p
< 0.001), which translated into significantly lower median hospital charges ($76,572 vs. $106,367,
p
< 0.001).
Conclusions
Contrary to fears regarding the potential for compromised outcomes early in the learning curve, LPD morbidity in its first decade is modestly reduced, while hospital costs are comparable to OPD. In high-volume pancreatic hospitals, LPD is associated with a reduction in length of stay and hospital costs.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-015-4444-y</identifier><identifier>PMID: 26275542</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Codes ; Databases, Factual ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Hospital Charges - statistics & numerical data ; Hospital costs ; Hospitals, High-Volume ; Hospitals, Low-Volume ; Humans ; Laparoscopy ; Laparoscopy - economics ; Learning Curve ; Learning curves ; Length of Stay - economics ; Logistic Models ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Mortality ; Outcome Assessment (Health Care) ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - economics ; Pancreaticoduodenectomy - methods ; Patient satisfaction ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Proctology ; Retrospective Studies ; Surgeons ; Surgery ; United States</subject><ispartof>Surgical endoscopy, 2016-05, Vol.30 (5), p.1778-1783</ispartof><rights>Springer Science+Business Media New York 2015</rights><rights>Springer Science+Business Media New York 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-23f2845b4bdc3b6d0069b3e639e8e7914d4ba0e4b55a08807a4a50cf36f2c3083</citedby><cites>FETCH-LOGICAL-c438t-23f2845b4bdc3b6d0069b3e639e8e7914d4ba0e4b55a08807a4a50cf36f2c3083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-015-4444-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-015-4444-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26275542$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tran, Thuy B.</creatorcontrib><creatorcontrib>Dua, Monica M.</creatorcontrib><creatorcontrib>Worhunsky, David J.</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Norton, Jeffrey A.</creatorcontrib><creatorcontrib>Visser, Brendan C.</creatorcontrib><title>The First Decade of Laparoscopic Pancreaticoduodenectomy in the United States: Costs and Outcomes Using the Nationwide Inpatient Sample</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Minimally invasive pancreaticoduodenectomy (PD) remains an uncommon procedure, and the safety and efficacy remain uncertain beyond single institution case series. The aim of this study is to compare outcomes and costs between laparoscopic (LPD) and open PD (OPD) using a large population-based database.
Methods
The Nationwide Inpatient Sample database (a sample of approximately 20 % of all hospital discharges) was analyzed to identify patients who underwent PD from 2000 to 2010. Patient demographics, comorbidities, hospital characteristics, inflation-adjusted total charges, and complications were evaluated using univariate and multivariate logistic regression. Hospitals were categorized as high-volume hospitals (HVH) if more than 20 PD (open and laparoscopic) were performed annually, while those performing fewer than 20 PD were classified as low-volume hospitals.
Results
Of the 15,574 PD identified, 681 cases were LPD (4.4 %). Compared to OPD, patients who underwent LPD were slightly older (65 vs. 67 years;
p
= 0.001) and were more commonly treated at HVH (56.6 vs. 66.1 %;
p
< 0.001). Higher rates of complications were observed in OPD than LPD (46 vs. 39.4 %;
p
= 0.001), though mortality rates were comparable (5 vs. 3.8 %,
p
= 0.27). Inflation-adjusted median hospital charges were similar between OPD and LPD ($87,577 vs. $81,833,
p
= 0.199). However, hospital stay was slightly longer in the OPD group compared to LPD group (12 vs. 11 days,
p
< 0.001). Stratifying outcomes by hospital volume, LPD at HVH resulted in shorter hospital stays (9 vs. 13 days,
p
< 0.001), which translated into significantly lower median hospital charges ($76,572 vs. $106,367,
p
< 0.001).
Conclusions
Contrary to fears regarding the potential for compromised outcomes early in the learning curve, LPD morbidity in its first decade is modestly reduced, while hospital costs are comparable to OPD. In high-volume pancreatic hospitals, LPD is associated with a reduction in length of stay and hospital costs.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Codes</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospital Charges - statistics & numerical data</subject><subject>Hospital costs</subject><subject>Hospitals, High-Volume</subject><subject>Hospitals, Low-Volume</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - economics</subject><subject>Learning Curve</subject><subject>Learning curves</subject><subject>Length of Stay - economics</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Outcome Assessment (Health Care)</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - economics</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Patient satisfaction</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>United States</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kV1rFDEUhoModq3-AG8k4I03Y0--ZjLeyWq1sLRCu9chk5ypU3aScZJB9hf4t812q0jB3ISQ531PyEPIawbvGUBzlgBkLStgqpJlVfsnZMWk4BXnTD8lK2gFVLxp5Ql5kdIdFLxl6jk54TVvlJJ8RX7dfEd6Pswp00_orEcae7qxk51jcnEaHP1mg5vR5sFFv0SPAV2O454OgeaS3YYho6fX2WZMH-g6ppyoDZ5eLdnFERPdpiHc3rOXpSWGn0OZchGmcsCQ6bUdpx2-JM96u0v46mE_Jdvzzzfrr9Xm6svF-uOmclLoXHHRcy1VJzvvRFd7gLrtBNaiRY1Ny6SXnQWUnVIWtIbGSqvA9aLuuROgxSl5d-yd5vhjwZTNOCSHu50NGJdkWKNVIxTTUNC3j9C7uMyhvO5AyboREkSh2JFy5cfSjL2Z5mG0894wMAdL5mjJFEvmYMnsS-bNQ_PSjej_Jv5oKQA_AqlchVuc_xn939bftk2eJw</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Tran, Thuy B.</creator><creator>Dua, Monica M.</creator><creator>Worhunsky, David J.</creator><creator>Poultsides, George A.</creator><creator>Norton, Jeffrey A.</creator><creator>Visser, Brendan C.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>The First Decade of Laparoscopic Pancreaticoduodenectomy in the United States: Costs and Outcomes Using the Nationwide Inpatient Sample</title><author>Tran, Thuy B. ; Dua, Monica M. ; Worhunsky, David J. ; Poultsides, George A. ; Norton, Jeffrey A. ; Visser, Brendan C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-23f2845b4bdc3b6d0069b3e639e8e7914d4ba0e4b55a08807a4a50cf36f2c3083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Codes</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospital Charges - statistics & numerical data</topic><topic>Hospital costs</topic><topic>Hospitals, High-Volume</topic><topic>Hospitals, Low-Volume</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - economics</topic><topic>Learning Curve</topic><topic>Learning curves</topic><topic>Length of Stay - economics</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Outcome Assessment (Health Care)</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - economics</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Patient satisfaction</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tran, Thuy B.</creatorcontrib><creatorcontrib>Dua, Monica M.</creatorcontrib><creatorcontrib>Worhunsky, David J.</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Norton, Jeffrey A.</creatorcontrib><creatorcontrib>Visser, Brendan C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tran, Thuy B.</au><au>Dua, Monica M.</au><au>Worhunsky, David J.</au><au>Poultsides, George A.</au><au>Norton, Jeffrey A.</au><au>Visser, Brendan C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The First Decade of Laparoscopic Pancreaticoduodenectomy in the United States: Costs and Outcomes Using the Nationwide Inpatient Sample</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>30</volume><issue>5</issue><spage>1778</spage><epage>1783</epage><pages>1778-1783</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Minimally invasive pancreaticoduodenectomy (PD) remains an uncommon procedure, and the safety and efficacy remain uncertain beyond single institution case series. The aim of this study is to compare outcomes and costs between laparoscopic (LPD) and open PD (OPD) using a large population-based database.
Methods
The Nationwide Inpatient Sample database (a sample of approximately 20 % of all hospital discharges) was analyzed to identify patients who underwent PD from 2000 to 2010. Patient demographics, comorbidities, hospital characteristics, inflation-adjusted total charges, and complications were evaluated using univariate and multivariate logistic regression. Hospitals were categorized as high-volume hospitals (HVH) if more than 20 PD (open and laparoscopic) were performed annually, while those performing fewer than 20 PD were classified as low-volume hospitals.
Results
Of the 15,574 PD identified, 681 cases were LPD (4.4 %). Compared to OPD, patients who underwent LPD were slightly older (65 vs. 67 years;
p
= 0.001) and were more commonly treated at HVH (56.6 vs. 66.1 %;
p
< 0.001). Higher rates of complications were observed in OPD than LPD (46 vs. 39.4 %;
p
= 0.001), though mortality rates were comparable (5 vs. 3.8 %,
p
= 0.27). Inflation-adjusted median hospital charges were similar between OPD and LPD ($87,577 vs. $81,833,
p
= 0.199). However, hospital stay was slightly longer in the OPD group compared to LPD group (12 vs. 11 days,
p
< 0.001). Stratifying outcomes by hospital volume, LPD at HVH resulted in shorter hospital stays (9 vs. 13 days,
p
< 0.001), which translated into significantly lower median hospital charges ($76,572 vs. $106,367,
p
< 0.001).
Conclusions
Contrary to fears regarding the potential for compromised outcomes early in the learning curve, LPD morbidity in its first decade is modestly reduced, while hospital costs are comparable to OPD. In high-volume pancreatic hospitals, LPD is associated with a reduction in length of stay and hospital costs.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26275542</pmid><doi>10.1007/s00464-015-4444-y</doi><tpages>6</tpages></addata></record> |
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| ispartof | Surgical endoscopy, 2016-05, Vol.30 (5), p.1778-1783 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Codes Databases, Factual Female Gastroenterology Gynecology Hepatology Hospital Charges - statistics & numerical data Hospital costs Hospitals, High-Volume Hospitals, Low-Volume Humans Laparoscopy Laparoscopy - economics Learning Curve Learning curves Length of Stay - economics Logistic Models Male Medicine Medicine & Public Health Middle Aged Morbidity Mortality Outcome Assessment (Health Care) Pancreaticoduodenectomy Pancreaticoduodenectomy - economics Pancreaticoduodenectomy - methods Patient satisfaction Postoperative Complications - epidemiology Postoperative Complications - etiology Proctology Retrospective Studies Surgeons Surgery United States |
| title | The First Decade of Laparoscopic Pancreaticoduodenectomy in the United States: Costs and Outcomes Using the Nationwide Inpatient Sample |
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