Peter Lundberg, MD, Alexander Thomas, BS, Christopher DuCoin, MD. Tulane University
Background: In this cost analysis it is hypothesized that peroral endoscopic myotomy (POEM) has a decreased total cost secondary to shorter operative time and reduced hospital stay when compared to laparoscopic Heller myotomy (LHM). These two surgical interventions are treatment options for achalasia, an esophageal motility disorder characterized by impaired peristalsis and relaxation of the lower esophageal sphincter (LES). Treatment for achalasia relies on reducing LES tone, for which medications, botox injections, and dilatation are used as temporary treatment options. The classic surgical option has been laparoscopic Heller myotomy combined with fundoplication. POEM has gained popularity in the last decade as a less invasive treatment that confers the benefits of myotomy. Its’ safety and non-inferiority to LHM has been established in the literature, however, there remains a paucity of data regarding its comparative expense.
Methods: A retrospective review of all POEM and LHM procedures performed by single surgeon at a single institution between September 2015 and September 2016 were analyzed. Using a proprietary institutional cost analysis database and medical records, demographics, length of stay, cost, and outcomes were compared. Data were calculated for mean and standard deviation. Patients were assigned into the LHM group if there was clinical history of gastroesophageal reflux disease or hiatal hernia greater than two centimeters.
Results: Four POEM and 7 LHM were performed. There were no significant differences in age, body mass index, or comorbidities between the two groups. Procedure length was shorter for POEM but not significant (131 minutes vs 192 minutes; p=0.07). POEM was found to have a shorter length of hospital stay (1.67 vs 3.71 days; p=0.05) as well as a decreased total cost ($6876 vs $11986; p=0.01). One patient in the LHM group developed post-operative atrial fibrillation. There were no other procedure-specific or general complications in either group nor were there any 30-day readmissions. All patients reported subjective improvement in dysphagia at their 2 week follow-up. One patient in the POEM group required increased proton pump inhibitor dosing due to worsened reflux symptoms.
Conclusions: POEM presents a significant cost improvement secondary to lower operative times and a decreased hospital length of stay compared to LHM. Larger multi-center studies with greater length of follow-up including more variety of payment models are needed to confirm these findings. Nonetheless, these findings encourage the increased adoption of POEM by physicians and insurers as a front-line treatment for achalasia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79682
Program Number: S086
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel