Severe Pancreatitis Multidisciplinary Working Group: Exploratory Analysis to Optimize Care and Cost

Area of Science:

• Gastroenterology
• Surgical Oncology
• Health Economics

Background:

• Minimally invasive "step-up" approaches enhance outcomes in pancreatitis management.
• Multidisciplinary working groups are crucial for implementing this approach.
• Financial sustainability is essential for supporting these specialized working groups.

Purpose of the Study:

• To test the hypothesis that surgical debridement in severe pancreatitis generates revenue to sustain multidisciplinary working groups.
• To determine if patients selected for surgical debridement by the working group show increased rates of percutaneous and endoscopic interventions.

Main Methods:

• An observational cohort study of 108 patients with severe acute and/or necrotizing pancreatitis managed by a multidisciplinary working group (October 2015-January 2019).
• Comparison of demographics, treatments, and outcomes between patients undergoing surgical debridement and those who did not.
• Analysis of hospital billing data for surgical debridement patients against institutional financial benchmarks.

Main Results:

• Ten patients (9.3%) required surgical debridement.
• Surgical debridement patients yielded a mean contribution margin of 60.34% (±16.66%), exceeding the 39% sustainability threshold (P=0.004).
• Patients undergoing surgical debridement were more likely to receive interventional radiology procedures (OR, 1.58; P=0.005), and had lower mortality (OR, 15; P=0.008) compared to the non-surgical group.

Conclusions:

• The multidisciplinary working group successfully implemented a step-up care approach for pancreatitis.
• Revenue generated from surgical debridement cases can financially support the operational costs of multidisciplinary pancreatitis care teams.
• This model demonstrates a pathway for financially sustainable, high-quality pancreatitis management.