Hospital charge and resource use analysis of extended-spectrum penicillin antibiotic therapy after pancreatoduodenectomy in intermediate- and high-risk patients.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-09-28 DOI:10.1016/j.hpb.2024.09.011

Alexander Loftus, Victoria S Wu, Mohamedraed Elshami, Jonathan J Hue, Lee M Ocuin

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引用次数: 0

Abstract

Background: We previously reported that an extended antibiotic mitigation pathway following pancreatoduodenectomy in patients with intermediate-/high-risk glands is associated with 83 % lower odds of clinically relevant postoperative pancreatic fistula (CR-POPF). We now describe associations between the pathway, resource utilization, and hospital charges.

Methods: We performed a retrospective cohort study of patients who underwent elective pancreatoduodenectomy with soft gland texture and fistula risk score (FRS) ≥3 who received standard or extended antibiotics. Hospital charges and resource utilization within 90 days of surgery were compared by CR-POPF status and antibiotic pathway.

Results: A total of 34 patients received extended antibiotics and 53 received standard antibiotics. In patients with CR-POPF, patients who received extended antibiotics had lower likelihood of surgical or percutaneous reintervention (75.0 % vs. 100.0 %, p = 0.022). Ninety-day postoperative charges associated with CR-POPF were higher than no CR-POPF ($60,527 vs. $25,631, p = 0.028). Our risk-based model predicted a $15,825 decrease in hospital charges per patient receiving extended antibiotics.

Conclusions: CR-POPF is associated with higher 90-day hospital charges. Extended antibiotic therapy following pancreatoduodenectomy in patients with soft gland texture and FRS ≥3 is associated with fewer reinterventions in patients who develop CR-POPF. These outcomes will be formally tested in a randomized controlled trial (NCT05753735).

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中高危患者胰十二指肠切除术后延长谱青霉素抗生素治疗的住院费用和资源使用分析。

背景：我们以前曾报道过，对中/高危腺体患者进行胰十二指肠切除术后延长抗生素缓解路径可降低 83% 的临床相关术后胰瘘 (CR-POPF) 发生几率。现在，我们将介绍该路径、资源利用率和住院费用之间的关联：我们对接受择期胰十二指肠切除术、腺体质地较软、瘘管风险评分（FRS）≥3、接受标准或延长抗生素治疗的患者进行了回顾性队列研究。根据 CR-POPF 状态和抗生素使用途径比较了手术后 90 天内的住院费用和资源使用情况：结果：共有 34 名患者接受了扩展抗生素治疗，53 名患者接受了标准抗生素治疗。在 CR-POPF 患者中，接受延长抗生素治疗的患者接受手术或经皮再介入治疗的可能性较低（75.0% 对 100.0%，P = 0.022）。与 CR-POPF 相关的术后九十天费用高于未使用 CR-POPF 的费用（60,527 美元对 25,631 美元，p = 0.028）。我们基于风险的模型预测，每位接受延长抗生素治疗的患者住院费用将减少 15,825 美元：结论：CR-POPF 与较高的 90 天住院费用有关。对于腺体质地较软、FRS ≥3的患者，胰十二指肠切除术后延长抗生素疗程可减少发生CR-POPF患者的再次干预。这些结果将在随机对照试验（NCT05753735）中进行正式检验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).