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What Drives High Costs of Cytoreductive Surgery and HIPEC: Patient, Provider or Tumor?

Annals of Surgical Oncology volume 27, pages 4920–4928 (2020)Cite this article

Abstract

Introduction

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is utilized for peritoneal malignancies and is associated with significant resource use. To address potentially modifiable factors contributing to excessive cost, we sought to determine predictors of high cost of care for patients undergoing CRS/HIPEC.

Methods

An institutional CRS/HIPEC database was queried for adult patients from 2014 to 2018. Cost was defined as cost for the index hospitalization, and high-cost cases were defined as > 75th percentile for cost. Bivariate analyses for cost were performed, and all significant tumor, patient, and surgeon-specific variables were entered in a linear regression for cost. A separate linear regression was performed for length of stay (LOS).

Results

In total, 59 patients underwent 61 CRS/HIPEC procedures. The median direct variable cost was $20,509 (16,395–25,240). Median length of stay (LOS) was 8 (7–11.5) days and ICU stay was 1 (1–1.5) day. LOS, length of ICU stay and operative time were predictive of cost. Factors associated with increased LOS were Clavien-Dindo grade II complications and ostomy creation. Patient-related factors, including age and BMI, tumor-related factors, such as PCI and CCR, and surgeon were not predictive of cost nor LOS.

Discussion

Our results, the first to identify predictors of high cost of CRS/HIPEC-related care in the US, reveal cost was largely related to length and intensity of care. In turn, these drivers were influenced by complications and operative factors. Future work will focus on identifying an appropriate ERAS protocol following CRS/HIPEC and selection of those patients that may avoid routine ICU admission.

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Acknowledgements

The authors would like to thank Deborah Lemaster for her assistance with data abstraction.

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number T32 CA090217 and Award Number T32 ES007015. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Patrick B. Schwartz MD, Christopher C. Stahl MD, Kara A. Vande Walle MD, Courtney J. Pokrzywa MD, Linda M. Cherney Stafford MPH, Taylor Aiken MD, James Barrett MD, Alexandra W. Acher MD, Glen Leverson PhD, Sean Ronnekleiv-Kelly MD, Sharon M. Weber MD & Daniel E. Abbott MD

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  1. Patrick B. Schwartz MD
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  2. Christopher C. Stahl MD
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Correspondence to Daniel E. Abbott MD.

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Schwartz, P.B., Stahl, C.C., Vande Walle, K.A. et al. What Drives High Costs of Cytoreductive Surgery and HIPEC: Patient, Provider or Tumor?. Ann Surg Oncol 27, 4920–4928 (2020). https://doi.org/10.1245/s10434-020-08583-7

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Keywords

  • HIPEC
  • Cytoreductive
  • Cost
  • Resource
  • Peritoneal