背景:已证明增强术后恢复(ERAS)方案可减少住院时间(LOS)和并发症。尚未研究ERAS方案对细胞减灭术和腹腔热化疗(CRS-HIPEC)成本的影响。
方法:我们对2016-2022年在单个四级中心接受CRS-HIPEC的患者进行了回顾性队列分析。倾向评分匹配用于创建ERAS前后队列。成本,整体和严重的并发症,两组患者的住院时间(LOS)和重症监护病房(ICU)住院时间(LOS)使用Mann-WhitneyU检验的连续变量和χ2检验的分类变量进行比较.
结果:我们的最终匹配队列包括100名患者,ERAS前后组50例患者。在调整了患者的复杂性和通货膨胀后,总成本中位数[$75,932($67,166-102,645)与$92,992($80,720-116,710),p=0.02]和手术室成本[$26,817($23,378-33,121)与$34,434($28,085-$41,379),p<0.001]在ERAS后队列中显著更高。总发病率(n=22,44%,n=17,34%,p=0.40)和ICU住院时间[2天(IQR1-3)与2天(IQR1-4),p=0.70]在两个队列之间相似。总成本增加22,393美元[SE13,047美元,95%CI(-3178美元至47,965美元),p=0.086]是在实施ERAS后估计的,手术室成本大大促进了这一增长[$8419,SE$1628,95%CI($5228-11,609),p<0.001]。
结论:CRS-HIPECERAS方案与较高的总成本相关,因为单个机构的手术室成本增加。实施ERAS方案后ICULOS和并发症无显著差异。
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been shown to reduce length of stay (LOS) and complications. The impact of ERAS protocols on the cost of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has not been studied.
METHODS: We performed a retrospective cohort analysis of patients undergoing CRS-HIPEC from 2016-2022 at a single quaternary center. Propensity score matching was used to create pre-and post-ERAS cohorts. Cost, overall and serious complications, and intensive care unit (ICU) length of stay (LOS) between the two cohorts were compared using the Mann-Whitney U-test for continuous variables and χ2 test for categorical variables.
RESULTS: Our final matched cohort consisted of 100 patients, with 50 patients in both the pre- and post-ERAS groups. After adjusting for patient complexity and inflation, the median total cost [$75,932 ($67,166-102,645) versus $92,992 ($80,720-116,710), p = 0.02] and operating room cost [$26,817 ($23,378-33,121) versus $34,434 ($28,085-$41,379), p < 0.001] were significantly higher in the post-ERAS cohort. Overall morbidity (n = 22, 44% versus n = 17, 34%, p = 0.40) and ICU length of stay [2 days (IQR 1-3) versus 2 days (IQR 1-4), p = 0.70] were similar between the two cohorts. A total cost increase of $22,393 [SE $13,047, 95% CI (-$3178 to $47,965), p = 0.086] was estimated after implementation of ERAS, with operating room cost significantly contributing to this increase [$8419, SE $1628, 95% CI ($5228-11,609), p < 0.001].
CONCLUSIONS: CRS-HIPEC ERAS protocols were associated with higher total costs due to increased operating room costs at a single institution. There was no significant difference in ICU LOS and complications after the implementation of the ERAS protocol.