VALUE ASSESSMENT FOR PATIENTS WHO UNDERWENT MINIMALLY INVASIVE VS OPEN COLECTOMIES AT A TERTIARY MEDICAL CENTER
Michael Abdelmasseh*1,2, Arslan Iqbal1,2, Douglas Melton2,3, Jonathan Willis2,3, vineela Kadiyala2,3, Juan-Ramon Sanabria1,2,4
1Marshall University School of Medicine Department of Surgery, Barboursville, WV; 2Marshall University Randomized Control Trials Enterprise, Barboursville, WV; 3Marshall University School of Medicine, Barboursville, WV; 4Case Western Reserve University, Cleveland, OH
BACKGROUND. It is estimated more than 300,000 colectomies will be performed in USA in 2019 at an estimated average reimbursement of $30,000 for a non-complicated case. Healthcare policies are assessing the value to determine schemes connecting reimbursement to performance. Our aim is to evaluate the value of colorectal procedures at our Institution after the introduction of enhanced recovery after surgery (ERAS) protocols for all types of procedures (laparoscopic, robotic-assisted and open), and to determine variables that affect their cost.
METHODS. Clinical variables (v=85) were defined in advanced and records from patients (>18yo) who underwent colorectal surgery were reviewed i) retrospectively (Aug-2010 to July-2016, n=223), and ii) prospectively (Aug-2016 to Dec-2018, n=126) under IRB approved protocols. Value defined as Quality/Cost was assessed where post-operative complications were graded using a classification system. Quality of procedures with no complications=1 value unit; other procedures with complications were given a quality score as Grade 1=0.95, Grade 2=0.75, Grade 3=0.60, Grade 4=0.50, and Grade 5=0 (Death=5). Cost was defined as hospital charges accrued for admission/re-admission up to 30 days post-index procedure. Cost was corrected for inflation at a 5% APR. Bivariate (t-test, Kruskal Wallis test, Wilcoxon Rank-sum) and multivariate (Multiple Regression) analyses were performed using R-lab software. Patients with no submitted billing cost (n=8) were excluded.
RESULTS. The unit value for uncomplicated robotic-assisted colectomy with no readmission and a LOS ≤ 4days was $55,149 (value unit=1). The values for open and laparoscopic procedures (uncomplicated vs complicated) are displayed in Figure 1. Bivariate and multivariate analyses were performed by complications and type of procedure (laparoscopic (11%), robotic-assisted (23%) or open (65%) averaging 61.1±13.5 years of age and 55% females. Modeling for the prediction of complications that accomplished the best value was constructed and predictors are being validated.
CONCLUSION. Under ERAS protocols, open colorectal procedures appear to have a higher value than minimally invasive procedures.
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