Can high-volume teams of anesthesiologists and surgeons decrease perioperative costs for pancreatic surgery?. Issue 5 (May 2019)

• Record Type: Journal Article
• Authors: Uppal, Abhineet; Vuong, Brooke; Dehal, Ahmed; Stern, Stacey L.; Mejia, Juan; Weerasinghe, Roshanthi; Kapoor, Vandana; Ong, Evan; Hansen, Paul D.; Bilchik, Anton J.
• Is Part Of: HPB. Volume 21:Issue 5(2019)
• Page Start: 589
• Page End: 595
• Publication Date: 2019-05
• Subjects: PD pancreaticoduodenectomy -- DP distal pancreatectomy -- HVA high volume anesthesiologist -- LVA low volume anesthesiologist -- HVS high volume surgeon -- LVS low volume surgeon -- HVT high volume team -- HVH high volume hospital -- LOS length of stay -- HPB hepatobiliary; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2018.09.008
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Pancreatic surgery outcomes are associated with surgeon and center experience. Anesthesiologists as potential value drivers for pancreatic surgery have not been explored. We sought to evaluate whether anesthesiologists impact perioperative costs for pancreatic surgery. Methods: Within an integrated health care system, 796 pancreatic surgeries (526 PDs and 270 DPs) were performed from January 2014 to June 2017. Mean direct operative and anesthesia costs driven by anesthesiologists (operating room (OR) time, anesthesia billing and anesthesia procedures) were determined for each case. The volumes of pancreatic cases per anesthesiologist were calculated, and those above the 75th percentile for volume (4 cases) were considered high-volume. A multivariable analysis of OR/anesthesia costs was performed. Results: Mean OR and anesthesia costs for PD were $7064 for low-volume anesthesiologists (LVA), higher than $5968 for high-volume anesthesiologists (HVA) (p < 0.001). By multivariable analysis, HVA were associated with decreased costs of $2278 (p < 0.001). Teams of HVA and high-volume surgeons (HVS) were also associated with decreased mean costs of $1790 (p = 0.04). Conclusion: These data suggest that anesthesiologists experienced in the management of complex pancreatic operations such as PDs may contribute to improved efficiencies in care by reducing perioperative costs.