Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy
Background Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery. Study design Patients were retrospectively identified betwee...
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| Veröffentlicht in: | The American surgeon 2020-06, Vol.86 (6), p.643-651 |
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| creator | Baimas-George, Maria Kirks, Russell C. Cochran, Allyson Baker, Erin H. Lauren Paton, B. Schiffern, Lynnette M. Matthews, Brent D. Martinie, John B. Vrochides, Dionisios Iannitti, David A. |
| description | Background
Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery.
Study design
Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors.
Results
One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created.
Conclusion
Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement. |
| doi_str_mv | 10.1177/0003134820923311 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2425589786</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0003134820923311</sage_id><sourcerecordid>2444866854</sourcerecordid><originalsourceid>FETCH-LOGICAL-c295t-921dd7e67f2c2f143db728a5dd2a07bf06f664901b8fa70c603fa53443ad2df93</originalsourceid><addsrcrecordid>eNp1kE1LAzEYhIMoWKt3jwEvXlbznd2jLK0KhXqwXpc0H7pld1OTrNh_b0oFoeDpZZhnhpcB4BqjO4ylvEcIUUxZSVBFKMX4BEww57yoSkJPwWRvF3v_HFzEuMmSCY4nYPWiUmuHBOdKJx8iXFhlYPJw9p3sENsvC99UaDPkB9gOcDkm7XsboRoMrH3MweB7WH_4zupdTDa39LtLcOZUF-3V752C1Xz2Wj8Vi-Xjc_2wKDSpeCoqgo2RVkhHNHGYUbOWpFTcGKKQXDsknBCsQnhdOiWRFog6xSljVBliXEWn4PbQuw3-c7QxNX0bte06NVg_xoYwwnlZyVJk9OYI3fgxDPm7TDFWClFylil0oHTwMQbrmm1oexV2DUbNfufmeOccKQ6RqN7tX-m__A80onux</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2444866854</pqid></control><display><type>article</type><title>Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy</title><source>SAGE Complete</source><creator>Baimas-George, Maria ; Kirks, Russell C. ; Cochran, Allyson ; Baker, Erin H. ; Lauren Paton, B. ; Schiffern, Lynnette M. ; Matthews, Brent D. ; Martinie, John B. ; Vrochides, Dionisios ; Iannitti, David A.</creator><creatorcontrib>Baimas-George, Maria ; Kirks, Russell C. ; Cochran, Allyson ; Baker, Erin H. ; Lauren Paton, B. ; Schiffern, Lynnette M. ; Matthews, Brent D. ; Martinie, John B. ; Vrochides, Dionisios ; Iannitti, David A.</creatorcontrib><description>Background
Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery.
Study design
Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors.
Results
One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created.
Conclusion
Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/0003134820923311</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Alcohol use ; Cholecystectomy ; Comorbidity ; Cost analysis ; Costs ; Datasets ; Diabetes ; Gallbladder ; Hospitals ; Laparoscopy ; Liver diseases ; Mortality ; Patients ; Statistical analysis ; Surgeons ; Surgery ; Trauma ; Variables</subject><ispartof>The American surgeon, 2020-06, Vol.86 (6), p.643-651</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c295t-921dd7e67f2c2f143db728a5dd2a07bf06f664901b8fa70c603fa53443ad2df93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0003134820923311$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0003134820923311$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids></links><search><creatorcontrib>Baimas-George, Maria</creatorcontrib><creatorcontrib>Kirks, Russell C.</creatorcontrib><creatorcontrib>Cochran, Allyson</creatorcontrib><creatorcontrib>Baker, Erin H.</creatorcontrib><creatorcontrib>Lauren Paton, B.</creatorcontrib><creatorcontrib>Schiffern, Lynnette M.</creatorcontrib><creatorcontrib>Matthews, Brent D.</creatorcontrib><creatorcontrib>Martinie, John B.</creatorcontrib><creatorcontrib>Vrochides, Dionisios</creatorcontrib><creatorcontrib>Iannitti, David A.</creatorcontrib><title>Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy</title><title>The American surgeon</title><description>Background
Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery.
Study design
Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors.
Results
One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created.
Conclusion
Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement.</description><subject>Alcohol use</subject><subject>Cholecystectomy</subject><subject>Comorbidity</subject><subject>Cost analysis</subject><subject>Costs</subject><subject>Datasets</subject><subject>Diabetes</subject><subject>Gallbladder</subject><subject>Hospitals</subject><subject>Laparoscopy</subject><subject>Liver diseases</subject><subject>Mortality</subject><subject>Patients</subject><subject>Statistical analysis</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Trauma</subject><subject>Variables</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kE1LAzEYhIMoWKt3jwEvXlbznd2jLK0KhXqwXpc0H7pld1OTrNh_b0oFoeDpZZhnhpcB4BqjO4ylvEcIUUxZSVBFKMX4BEww57yoSkJPwWRvF3v_HFzEuMmSCY4nYPWiUmuHBOdKJx8iXFhlYPJw9p3sENsvC99UaDPkB9gOcDkm7XsboRoMrH3MweB7WH_4zupdTDa39LtLcOZUF-3V752C1Xz2Wj8Vi-Xjc_2wKDSpeCoqgo2RVkhHNHGYUbOWpFTcGKKQXDsknBCsQnhdOiWRFog6xSljVBliXEWn4PbQuw3-c7QxNX0bte06NVg_xoYwwnlZyVJk9OYI3fgxDPm7TDFWClFylil0oHTwMQbrmm1oexV2DUbNfufmeOccKQ6RqN7tX-m__A80onux</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Baimas-George, Maria</creator><creator>Kirks, Russell C.</creator><creator>Cochran, Allyson</creator><creator>Baker, Erin H.</creator><creator>Lauren Paton, B.</creator><creator>Schiffern, Lynnette M.</creator><creator>Matthews, Brent D.</creator><creator>Martinie, John B.</creator><creator>Vrochides, Dionisios</creator><creator>Iannitti, David A.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, 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Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy</title><author>Baimas-George, Maria ; Kirks, Russell C. ; Cochran, Allyson ; Baker, Erin H. ; Lauren Paton, B. ; Schiffern, Lynnette M. ; Matthews, Brent D. ; Martinie, John B. ; Vrochides, Dionisios ; Iannitti, David A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c295t-921dd7e67f2c2f143db728a5dd2a07bf06f664901b8fa70c603fa53443ad2df93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Alcohol use</topic><topic>Cholecystectomy</topic><topic>Comorbidity</topic><topic>Cost analysis</topic><topic>Costs</topic><topic>Datasets</topic><topic>Diabetes</topic><topic>Gallbladder</topic><topic>Hospitals</topic><topic>Laparoscopy</topic><topic>Liver diseases</topic><topic>Mortality</topic><topic>Patients</topic><topic>Statistical analysis</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Trauma</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baimas-George, Maria</creatorcontrib><creatorcontrib>Kirks, Russell C.</creatorcontrib><creatorcontrib>Cochran, Allyson</creatorcontrib><creatorcontrib>Baker, Erin H.</creatorcontrib><creatorcontrib>Lauren Paton, B.</creatorcontrib><creatorcontrib>Schiffern, Lynnette M.</creatorcontrib><creatorcontrib>Matthews, Brent D.</creatorcontrib><creatorcontrib>Martinie, John B.</creatorcontrib><creatorcontrib>Vrochides, Dionisios</creatorcontrib><creatorcontrib>Iannitti, David A.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and 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Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baimas-George, Maria</au><au>Kirks, Russell C.</au><au>Cochran, Allyson</au><au>Baker, Erin H.</au><au>Lauren Paton, B.</au><au>Schiffern, Lynnette M.</au><au>Matthews, Brent D.</au><au>Martinie, John B.</au><au>Vrochides, Dionisios</au><au>Iannitti, David A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy</atitle><jtitle>The American surgeon</jtitle><date>2020-06</date><risdate>2020</risdate><volume>86</volume><issue>6</issue><spage>643</spage><epage>651</epage><pages>643-651</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Background
Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery.
Study design
Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors.
Results
One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created.
Conclusion
Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><doi>10.1177/0003134820923311</doi><tpages>9</tpages></addata></record> |
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| subjects | Alcohol use Cholecystectomy Comorbidity Cost analysis Costs Datasets Diabetes Gallbladder Hospitals Laparoscopy Liver diseases Mortality Patients Statistical analysis Surgeons Surgery Trauma Variables |
| title | Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy |
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