TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION REDUCES RESOURCE UTILIZATION IN PEDIATRIC PATIENTS
Al-Faraaz Kassam*1,2, Alexander R. Cortez1,2, Michael E. Johnston1,2, Huaiyu Zang2, Lin Fei2, Tom K. Lin2, Maisam Abu-El-Haija2, Jaimie D. Nathan2
1University of Cincinnati College of Medicine, Cincinnati, OH; 2Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Introduction
Chronic pancreatitis (CP) is associated with significant morbidity and debilitation in children. CP has been shown to be associated with poor quality of life, high opioid usage, multiple hospitalizations with pain and pancreatitis attacks, and high resource utilization. Nonetheless, total pancreatectomy with islet autotransplantation (TPIAT) has typically been considered only after years of recurrent admissions to the hospital and numerous procedures. We hypothesized that TPIAT would lead to decreased costs and resource utilization after operation in children.
Methods
We performed a retrospective review of 39 pediatric patients who underwent TPIAT at a single tertiary care children’s hospital from 2015 to 2018, all of whom had one year of follow up. All inpatient admissions, imaging procedures, endoscopic procedures, and operations were recorded for the year prior to and one year following operation. Cost of procedures and hospitalizations were determined using data obtained from the Centers for Medicare and Medicaid Services in US dollars. Analysis was performed using t-tests and a p-value <0.05 was considered statistically significant.
Results
In the year prior to operation, median number of hospital admissions was 5 (IQR 2-7) with median cost of $26,178 (IQR $10,471-$36,649) (Table). This decreased to a median number of admissions of 2 (IQR 1-3) and cost of $19,572 (IQR $14,336-$24,807) in the year after operation (including the admission for TPIAT itself) (both p<0.01). There was no difference in median length of stay across all hospitalizations before and after operation (26 vs 29 days, p=0.64). Significant decreases were seen in number of MRIs (1 vs 0, p<0.01) and endoscopic retrograde cholangiopancreatography procedures (2 vs 0, p<0.01) in the year following operation (Figure). Increases were seen post-operatively in number of radiographs (9 vs 3, p<0.01) and ultrasound studies (4 vs 2, p=0.03). Median total cost for the year before operation for all admissions, imaging, and procedures was calculated at $36,006 (IQR $19,914-$47,680) which decreased by $12,000 to a median cost of $24,900 post-operatively (IQR $17,432-$44,005) (p=0.03). When removing the cost of the TPIAT itself, the median cost was further significantly reduced to $10,564 (IQR $3,096-$29,669) (p<0.01).
Conclusion
In pediatric patients with debilitating CP, TPIAT has a favorable effect on cost reduction, number of hospitalizations, and number of invasive procedures. While TPIAT is a major operation with potential morbidity, early intervention at specialized pancreas centers of excellence with multidisciplinary care should be considered to decrease future resource utilization and costs among these patients. Further work is needed to understand the impact of TPIAT on health-related quality of life in this population and long-term cost benefit.
Change in median number of endoscopic interventions, imaging studies, and hospital admissions within one year prior to and after operation.
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