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Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy
Published on: November 20, 2021
Total pancreatectomy with islet autotransplantation reduces resource utilization in pediatric patients
Al-Faraaz Kassam1, Alexander R Cortez1, Michael E Johnston1
1Cincinnati Children's Hospital Medical Center, Division of Pediatric General and Thoracic Surgery, Cincinnati, OH, USA; University of Cincinnati Medical Center, Department of Surgery, Cincinnati, OH, USA.
Insights
Total pancreatectomy with islet autotransplantation (TPIAT) significantly reduces costs and hospitalizations for children with chronic pancreatitis (CP). Early intervention at specialized centers is recommended for better outcomes and resource utilization.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Health Economics
Background:
- Chronic pancreatitis (CP) severely impacts children's quality of life.
- Total pancreatectomy with islet autotransplantation (TPIAT) is typically a last resort for severe CP.
- This study investigates the economic and resource impact of TPIAT in pediatric patients.
Purpose of the Study:
- To evaluate the hypothesis that TPIAT decreases costs and resource utilization in children with CP.
- To quantify changes in hospital admissions, procedures, and overall healthcare costs before and after TPIAT.
Main Methods:
- Retrospective review of 39 pediatric patients undergoing TPIAT.
- Data collected included inpatient admissions, imaging, endoscopic procedures, and operations.
- Costs were calculated using Centers for Medicare and Medicaid Services data.
Main Results:
- Hospital admissions decreased from a median of 5 to 2 post-TPIAT (p < 0.01).
- Total annual costs decreased from $36,006 to $24,900 (p = 0.03).
- Excluding TPIAT costs, overall expenses reduced to $10,564 (p < 0.01).
Conclusions:
- TPIAT favorably impacts cost reduction, hospitalizations, and invasive procedures in pediatric CP.
- Early TPIAT at specialized centers may decrease long-term resource utilization and costs.
- This suggests TPIAT is a viable option for managing debilitating pediatric CP.
Background:
Chronic pancreatitis (CP) is associated with poor quality of life. Total pancreatectomy with islet autotransplantation (TPIAT) has traditionally been reserved for patients with refractory disease. We hypothesized TPIAT would lead to decreased costs and resource utilization after operation in children.
Methods:
Retrospective review of 39 patients who underwent TPIAT at a single children's hospital was performed. All inpatient admissions, imaging, endoscopic procedures, and operations were recorded for the year prior to and following operation. Costs were determined from Centers for Medicare and Medicaid Services.
Results:
Median hospital admissions before operation was 5 (IQR:2-7) and decreased to 2 (IQR:1-3) after (p < 0.01). Median total cost for the year before operation was $36,006 (IQR:$19,914-$47,680), decreasing to $24,900 postoperatively (IQR:$17,432-$44,005, p = 0.03). Removing cost of TPIAT itself, total cost was further reduced to $10,564 (IQR:$3096-$29,669, p < 0.01).
Conclusion:
In children with debilitating CP, TPIAT has favorable impact on cost reduction, hospitalizations, and invasive procedures. Early intervention at a specialized pancreas center of excellence should be considered to decrease future resource utilization and costs among children.
