Kenneth W Bueltmann, MD, Marek Rudnicki, MD. Advocate Illinois Masonic Medical Center
Introduction: Intraoperative cholangiogram (IOC) procedures have endured the test of time. Although modern technology provides worthy alternatives to IOC utilization during laparoscopic procedures, the decision to perform the procedure is maintained by supporters worldwide. It may be possible that this bias represents a benefit to the patient as well as the system. Big data allows for a discrete investigation regarding the outcomes of surgeries accompanied by IOC, including its financial implications.
Methods: The Nationwide Inpatient Sample was queried for all laparoscopic cholecystectomies (ICD-9 code=5123) undertaken from 1998 to 2013 (n=1,103,725). Elixhauser comorbidity was coded using HCUP comorbidity software. Van Walraven’s summarized method was used to score comparisons. Surgical complications were also coded and summarized. A control subset (n=333,320) was identified from those patients, 18 to 65 years old, cancer free and free from comorbidity and complexity, having a laparoscopic cholecystectomy. Patients with IOC (ICD-9=8753) were identified in both groups. SAS Enterprise 6.1 was utilized to compute mean total charges and to calculate IOC cost and the financial burden of complications in their respective groupings. Estimated average yield for the time period was then calculated.
Results: Average total charges in the complicated group were found to be 60% higher in patients with related surgical complications ($34,824 vs $21,757, p<.0001). The average total charges for IOC(+) and IOC(-) patients in our control group was $22,892 ± $59 and $21,203 ± $39, respectively. Calculated average charge for an IOC was $1,591 to $1,709. The average total charge for an IOC(-) patient with just one surgically related complication was $31,667 ± $730. The additional charge for one surgical complication was calculated to be $9,695 to $11,231. The rate of surgically related complications was found to be lower in the IOC(+) group when compared to the IOC(-) (1.87% vs 2.01%, p<.0001). Total financial burden of surgical complications for 6,631 complex LC cases was 64.3M – 74.5M dollars. Total cost of IOC would be 10.6M to 11.3M dollars. Average percent yield was 14% to 17%.
Conclusion: Objective initiatives concerning improved patient care are not considered to be complete without thorough financial analysis. Given the current US economy, an investment with yields over 10% are hard to come by. The risk of capital is likely to be offset by savings associated with IOC use and likely reduction in complexity. The value of these metrics in developing future healthcare policy should not be ignored.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80640
Program Number: P644
Presentation Session: Poster (Non CME)
Presentation Type: Poster
