>Year 2010, Issue 3
Domínguez I, Chan C, López-Tello A, Alonso M, Uscanga LF, Campuzano M
Costs related to post-operative pancreatic fistula. Experience at a high volume Latin American center
Cir Gen 2010; 32 (3)
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Objective: 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.
||Pancreatic fistula, pancreatectomy, complications, surgery of the pancreas.
Chan C, Franssen B, Rubio A, Uscanga L. Pancreaticoduodenectomy in a Latin American country: the transition to a high-volume center. J Gastrointest Surg 2008; 12: 527-533.
Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the international study group of pancreatic fistula (ISGPF) classification scheme. Ann Surg 2007; 245: 443-451.
Veillette G, Domínguez I, Ferrone C, Thayer SP, McGrath D, Wasrshaw AL, et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg 2008; 143: 476-481.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138: 8-13.
Rodríguez JR, Soto-Germes S, Pandharipande VP, Gazelle GS, Thayer SP, Warshaw AL, et al. Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg 2006; 141: 361-366.
Strasberg SM, Linehan DC, Clavien PA, Barkun JS. Proposal for definition and severity grading of pancreatic anastomosis failure and pancreatic occlusion failure. Surgery 2007; 141: 420-426
Vin Y, Sima CS, Getrajdman GI, Brown KT, Covey A, Brennan MF, et al. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 2008; 207: 490-498.
>Year 2010, Issue 3