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Back to 2014 Annual Meeting Abstracts
Comparison of Hospital Charges Between Laparoscopic Heller Myotomy and POEM
Ezra N. Teitelbaum*, Nathaniel J. Soper, Peter J. Kahrilas, John E. Pandolfino, Eric S. Hungness
Northwestern University, Chicago, IL
INTRODUCTION: Peroral esophageal myotomy (POEM) is a novel surgical operation for the treatment of achalasia. In this study, we compared inpatient hospital charges between POEM and laparoscopic Heller myotomy (LHM).
METHODS: All POEM procedures performed at a single institution until the time of analysis were studied. All LHMs performed during the same time period served as a comparison group. During the study period, patients with achalasia were informed of their treatment options (pneumatic dilation, LHM, and POEM) and chose a procedure in consultation with their physicians. Total charges for each procedure and subsequent hospitalization were derived from the hospital's billing database. Charges within the following sub-categories were additionally compared: 1) Primary procedure, 2) instrumentation, 3) anesthesia, 4) non-OR medications, 5) laboratory testing, 6) radiologic studies, and 7) other diagnostic testing.
RESULTS: The initial 29 POEM procedures performed at the institution were analyzed, and 23 patients underwent LHM during the same time period. POEM patients were younger (mean 43±15 vs. 54±16 years, p=.01) and fewer POEM patients had received prior endoscopic therapy for achalasia (10% vs. 57%, p<.001). The procedure groups were otherwise similar in terms of gender distribution, BMI, ASA classification, duration of symptoms, manometric relaxation pressure, and achalasia sub-type. POEM cases had shorter operative times (mean 115 ±39 vs. 148 ±27 minutes, p=.001). Median length of stay was 1 day for both procedures (range POEM: 1-13 and LHM: 1-2 days, p=ns). One (3%) major complication (Grade IIIb) occurred as a result of POEM and none occurred for LHM (p=ns). Two (7%) minor complications (all Grade I) occurred for POEM and 4 (17%) minor complications (all Grade I) occurred after LHM (p=ns). Total charges were similar between procedure groups (POEM: $34,395 ±18,962 vs. LHM: $33,738 ±7,737, p=ns). POEM had lower OR instrumentation charges (mean $591 ±324 vs. $2,626 ±517, p<.001). All POEM patients underwent a per-protocol contrast esophagram on postoperative day one to rule out leak, whereas only 3 (13%) LHM patients had a similar study (p<.001). Resulting charges for radiologic studies were higher for POEM patients (mean $902 ±507 vs. $83 ±222, p<.001). Charges with the sub-categories of primary procedure, anesthesia, non-OR medications, laboratory testing, and other diagnostic studies were similar between POEM and LHM. If the POEM patient with the major complication was removed from the analysis, mean total charges for POEM and LHM remained similar (POEM: $31,091 ±6,669 vs. LHM: $33,738 ±7,737, p=ns).
CONCLUSIONS: In this single-institution series, POEM and LHM resulted in similar total hospital charges. POEM incurred lower OR instrumentation charges, but higher radiology charges when a routine postoperative esophagram was performed.
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