2010, Number 3
Costs related to post-operative pancreatic fistula. Experience at a high volume Latin American center
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ABSTRACTObjective: To know the prevalence of high clinical impact fistula and direct costs related with this post-operative complication.
Setting: Third level health care center, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City.
Design: Retrospective, transversal, study, and cost-savings analysis.
Statistical analysis: Chi square, ANOVA, Kruskal-Wallis and analytical decision model with the equation of a straight line.
Patients and methods: We analyzed 99 cases of a total of 200 patients cared for by a single surgeon; divided in three groups: 1) high clinical impact fistulae, 2) low clinical impact fistula, 3) without fistula. Assessed variables were: age, gender, type of surgery, comorbidities, symptoms at diagnosis, in-hospital stay after the surgery, total time of in-hospital stay, hospital re-admittances, histopathological diagnosis, post-operative complications not directly related with the surgical procedure, time of follow-up, and peri-operative mortality associated directly with the surgical procedure. Costs of: in-hospital stay per day, intensive therapy, surgical interventions, and interventionist radiology procedures, parenteral nutrition, general surgery and sub-specialties follow-up consultations, as well as laboratory and imaging studies during the first post-operative year.
Results: Prevalence of the high clinical impact fistula was of 19%. Total costs were significantly higher for the group of high impact fistulas, almost twice of those of the other two groups, with an absolute difference in total costs of MX$73,751.00.
Conclusion: Because of the prevalence and the evident high cost secondary to the diagnosis and management of this complication, it is indispensable to start strategies for its prevention and treatment.
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