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Cost of Bile Duct Injury: Surgical vs Endoscopic Management
Vol. 225, No. 4S1, October 2017
Scientific Forum Abstracts
S113
payment with the effort involved for laparoscopy. Incentivizing surgeons to use minimally invasive approaches could further increase utilization and improve overall outcomes, cost, and quality as we shift to a value-based payment system.
patients without BDIs. While operative management was associated with higher initial cost than endoscopic management, the cumulative cost for surgical management was lower after 90 days, with a differential cost of $58,000 at 1 year.
Cost of Bile Duct Injury: Surgical vs Endoscopic Management Zhi Ven Fong, MD, Henry A Pitt, MD, FACS, Jason K Sicklick, MD, FACS, Steven M Strasberg, MD, FACS, Andrew P Loehrer, MD, MPH, Mark A Talamini, MD, FACS, Keith D Lillemoe, MD, FACS, David C Chang, PhD, MBA, MPH Massachusetts General Hospital, Boston, MA
Disaster Simulation: What We Have Done and What We Have Learned Pedro L Mellucci, MD, Willy J Macedo Netto, MD, Fernando L Pereira, MD, Alexandre S Campos, MD, Bruna M Laursen, Camila P Sannino, Isabella B Rodrigues, Juliana Seribeli, MD, Keiny S Pinotti, Lyara MM Queiroz Presidente Prudente Regional Hospital, Presidente Prudente, Brazil
INTRODUCTION: The clinical impact of bile duct injuries (BDI) after cholecystectomy has been well documented. However, the longitudinal impact of BDI on health care utilization and cost are largely limited to single-institution case series or to Medicare patients. METHODS: The California Office of Statewide Health Planning and Development database inpatient and emergency department (ED) files were queried (2005 to 2014). Inflation adjustments were applied to charges, which were converted to cost by multiplying by hospital-specific cost-to-charge ratios. Comparative analyses of BDIs managed surgically and endoscopically were performed in an intention-to-treat fashion. RESULTS: Of 711,454 cholecystectomies, BDIs occurred in 1,493 patients (0.21%), of which 1,277 were managed surgically and 216 endoscopically. When compared with patients without BDIs, patients with BDIs had higher 1-year ED visit rates, readmission rates, and cumulative cost. When analyzing patients with BDIs by management approach (surgical vs endoscopic), operatively managed BDIs were associated with lower 1-year ED visit rates and readmission rates, but cost at the time of repair was higher ($37,687 vs $25,705, p < 0.001, Figure). However, endoscopically managed BDIs began to have a higher cumulative cost at 90 days ($56,972 vs $51,183, p < 0.001) and beyond. This difference was even more pronounced at 1 year ($118,245 vs $60,539, p < 0.001, Figure).
INTRODUCTION: Simulation-based education is an important tool for medical students and health care professionals because it complements traditional methods, granting practice in safe and standardized environments. We sought to achieve a role model for off-site simulation-based disasters, presenting the results of 4 years of disaster simulations conducted in Presidente Prudente, Brazil. METHODS: We performed a retrospective analysis and methodology used in 4 disaster simulations conducted annually between 2013 and 2016, totaling 366 victims, an average of 91.5 per year, involving 5 major hospitals and municipal public entities (over 400 professionals each year). We focused on the pre-hospital moment, using the START (Simple Triage and Rapid Treatment) method, until the initial assessment in the emergency room. RESULTS: The amount of time taken for each simulation was directly correlatable to the scene time each year, totalizing 8 hours and 37 minutes of simulation experience in 4 years. An inverse upand-down curve has been noted in the reported number of victims and average attendance time in each hospital, showing inverse correlation between the number of victims attended and the assessment time. CONCLUSIONS: Disaster simulations brought an immeasurable benefit for medical education and the municipal health care system on a very low budget, becoming an increasingly successful annual activity sought by various students and health professionals, changing the system scene and giving a sense of readiness for each professional involved. The hospitals are now aware of the data gathered, including the correlation between victims attended to and assessment time, allowing a better preparation for the management of any possible disaster. Disparities in Laparoscopic Resection in the Elective Treatment of Diverticulitis Asif Talukder, Randi L Lassiter, MD, Patricia Martinez-Quinones, MD, Cassandra Q White, MD, Daniel Albo, MD, FACS, Jinsol Oh, MD Augusta University, Augusta, GA
CONCLUSIONS: Patients with BDIs had higher health care utilization rates and cumulative cost of care when compared with
INTRODUCTION: Studies have demonstrated favorable outcomes for laparoscopic surgery over open surgery in the treatment of a
Scientific Forum Abstracts
S113
payment with the effort involved for laparoscopy. Incentivizing surgeons to use minimally invasive approaches could further increase utilization and improve overall outcomes, cost, and quality as we shift to a value-based payment system.
patients without BDIs. While operative management was associated with higher initial cost than endoscopic management, the cumulative cost for surgical management was lower after 90 days, with a differential cost of $58,000 at 1 year.
Cost of Bile Duct Injury: Surgical vs Endoscopic Management Zhi Ven Fong, MD, Henry A Pitt, MD, FACS, Jason K Sicklick, MD, FACS, Steven M Strasberg, MD, FACS, Andrew P Loehrer, MD, MPH, Mark A Talamini, MD, FACS, Keith D Lillemoe, MD, FACS, David C Chang, PhD, MBA, MPH Massachusetts General Hospital, Boston, MA
Disaster Simulation: What We Have Done and What We Have Learned Pedro L Mellucci, MD, Willy J Macedo Netto, MD, Fernando L Pereira, MD, Alexandre S Campos, MD, Bruna M Laursen, Camila P Sannino, Isabella B Rodrigues, Juliana Seribeli, MD, Keiny S Pinotti, Lyara MM Queiroz Presidente Prudente Regional Hospital, Presidente Prudente, Brazil
INTRODUCTION: The clinical impact of bile duct injuries (BDI) after cholecystectomy has been well documented. However, the longitudinal impact of BDI on health care utilization and cost are largely limited to single-institution case series or to Medicare patients. METHODS: The California Office of Statewide Health Planning and Development database inpatient and emergency department (ED) files were queried (2005 to 2014). Inflation adjustments were applied to charges, which were converted to cost by multiplying by hospital-specific cost-to-charge ratios. Comparative analyses of BDIs managed surgically and endoscopically were performed in an intention-to-treat fashion. RESULTS: Of 711,454 cholecystectomies, BDIs occurred in 1,493 patients (0.21%), of which 1,277 were managed surgically and 216 endoscopically. When compared with patients without BDIs, patients with BDIs had higher 1-year ED visit rates, readmission rates, and cumulative cost. When analyzing patients with BDIs by management approach (surgical vs endoscopic), operatively managed BDIs were associated with lower 1-year ED visit rates and readmission rates, but cost at the time of repair was higher ($37,687 vs $25,705, p < 0.001, Figure). However, endoscopically managed BDIs began to have a higher cumulative cost at 90 days ($56,972 vs $51,183, p < 0.001) and beyond. This difference was even more pronounced at 1 year ($118,245 vs $60,539, p < 0.001, Figure).
INTRODUCTION: Simulation-based education is an important tool for medical students and health care professionals because it complements traditional methods, granting practice in safe and standardized environments. We sought to achieve a role model for off-site simulation-based disasters, presenting the results of 4 years of disaster simulations conducted in Presidente Prudente, Brazil. METHODS: We performed a retrospective analysis and methodology used in 4 disaster simulations conducted annually between 2013 and 2016, totaling 366 victims, an average of 91.5 per year, involving 5 major hospitals and municipal public entities (over 400 professionals each year). We focused on the pre-hospital moment, using the START (Simple Triage and Rapid Treatment) method, until the initial assessment in the emergency room. RESULTS: The amount of time taken for each simulation was directly correlatable to the scene time each year, totalizing 8 hours and 37 minutes of simulation experience in 4 years. An inverse upand-down curve has been noted in the reported number of victims and average attendance time in each hospital, showing inverse correlation between the number of victims attended and the assessment time. CONCLUSIONS: Disaster simulations brought an immeasurable benefit for medical education and the municipal health care system on a very low budget, becoming an increasingly successful annual activity sought by various students and health professionals, changing the system scene and giving a sense of readiness for each professional involved. The hospitals are now aware of the data gathered, including the correlation between victims attended to and assessment time, allowing a better preparation for the management of any possible disaster. Disparities in Laparoscopic Resection in the Elective Treatment of Diverticulitis Asif Talukder, Randi L Lassiter, MD, Patricia Martinez-Quinones, MD, Cassandra Q White, MD, Daniel Albo, MD, FACS, Jinsol Oh, MD Augusta University, Augusta, GA
CONCLUSIONS: Patients with BDIs had higher health care utilization rates and cumulative cost of care when compared with
INTRODUCTION: Studies have demonstrated favorable outcomes for laparoscopic surgery over open surgery in the treatment of a