背景:慢性胰腺炎(CP)与生活质量差有关。传统上,带有胰岛自体移植的全胰腺切除术(TPIAT)被保留用于难治性疾病患者。我们假设TPIAT会降低儿童手术后的成本和资源利用率。
方法:回顾性分析了39名在一家儿童医院接受TPIAT的患者。所有住院患者,成像,内窥镜手术,和操作记录了操作之前和之后的一年。费用由医疗保险和医疗补助服务中心确定。
结果:术前住院人数中位数为5(IQR:2-7),术后下降至2(IQR:1-3)(p<0.01)。运营前一年的总成本中位数为$36,006(IQR:$19,914-$47,680),术后降至24,900美元(IQR:17,432美元-44,005美元,p=0.03)。消除TPIAT本身的成本,总成本进一步降至10,564美元(IQR:3096美元-29,669美元,p<0.01)。
结论:在患有衰弱性CP的儿童中,TPIAT对降低成本有有利的影响,住院治疗,和侵入性程序。应考虑在专门的胰腺卓越中心进行早期干预,以减少儿童未来的资源利用和成本。
BACKGROUND: Chronic pancreatitis (CP) is associated with poor quality of life. Total pancreatectomy with islet autotransplantation (
TPIAT) has traditionally been reserved for patients with refractory disease. We hypothesized
TPIAT would lead to decreased costs and resource utilization after operation in children.
METHODS: Retrospective review of 39 patients who underwent
TPIAT at a single children\'s hospital was performed. All inpatient admissions, imaging, endoscopic procedures, and operations were recorded for the year prior to and following operation. Costs were determined from Centers for Medicare and Medicaid Services.
RESULTS: Median hospital admissions before operation was 5 (IQR:2-7) and decreased to 2 (IQR:1-3) after (p < 0.01). Median total cost for the year before operation was $36,006 (IQR:$19,914-$47,680), decreasing to $24,900 postoperatively (IQR:$17,432-$44,005, p = 0.03). Removing cost of
TPIAT itself, total cost was further reduced to $10,564 (IQR:$3096-$29,669, p < 0.01).
CONCLUSIONS: In children with debilitating CP,
TPIAT has favorable impact on cost reduction, hospitalizations, and invasive procedures. Early intervention at a specialized pancreas center of excellence should be considered to decrease future resource utilization and costs among children.