Resident/Graduate Student University of Wisconsin, Madison Madison, Wisconsin, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Patrick B. Schwartz, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: Patients undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) are frequently admitted to the Intensive Care Unit (ICU) to mitigate potential complications, though we have previously shown that ICU length of stay (LOS) is a significant driver of cost. Therefore, we sought to understand whether a fiscal argument could be made for the selective avoidance of routine ICU admission for patients undergoing CRS/HIPEC.
Methods: Prospective data from 2019-2021 for select low-risk patients admitted to the Intermediate Care Unit (IMC) after undergoing curative intent CRS/HIPEC, were matched to a historic cohort from 2014-2019 routinely admitted to the ICU on relevant patient (ASA Class) and tumoral characteristics (PCI and tumor histology). Comparisons were made with Wilcoxon and Chi-Squared/Fisher’s Exact test as appropriate and data presented as the median with IQR. To determine the impact of the intervention on cost, a weighted multiple variable linear regression was performed.
Results: In total, 83 patients undergoing 87 procedures (71 pre-/ 16 post-intervention) were matched to form a cohort consisting of 49 pre- and 15 post-intervention patients. Patients in the pre-intervention cohort stayed 1 day longer in the ICU (1 [1-1] vs 0 [0-0]; p< 0.01) and had a longer LOS (8 [7-11] vs 6 [5.5-9]; p=0.04). However, the cohorts had similar rates of severe (Clavien-Dindo Grade ≥3) complications (20.4% vs 13.3%; p=0.54). The total hospital cost was found to be significantly lower post-intervention ($30,845 [30,181-37,725] vs $41,477 [33,303-51,838]; p< 0.01), primarily driven by a decrease in indirect fixed costs ($8,984 [8,643-11,286] vs $14,314 [12,206-18,266]; p< 0.01). On regression analysis, the intervention was associated with a cost savings of $2,262 (p=0.02) (Figure 1).
Conclusions: In this matched study, we have shown selective admission of patients to the IMC after CRS/HIPEC was associated with a cost savings of $2,262 without significant risk to the patient. In the era of the cost-conscious practice of medicine, these data highlight an opportunity to decrease the total cost of care by over 5% for patients undergoing CRS/HIPEC.
Learning Objectives:
describe the different classifications of hospital cost.
list the fiscal benefits of avoiding routine ICU admission following CRS/HIPEC.
critically evaluate the need for routine ICU admission following CRS/HIPEC.
