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Rethinking Routine Intensive Care After Cytoreductive Surgery With Heated Intraperitoneal Chemotherapy: The Fiscal Argument

  • Peritoneal Surface Malignancy
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients undergoing cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) are frequently admitted to the intensive care unit (ICU) for mitigation of potential complications, although ICU length of stay (LOS) is a significant driver of cost. This study asked whether a fiscal argument could be made for the selective avoidance of ICU admission after CRS/HIPEC.

Methods

Prospective data for select low-risk patients (e.g., lower peritoneal cancer index [PCI]) admitted to the intermediate care unit (IMC) instead of the ICU after CRS/HIPEC were matched with a historic cohort routinely admitted to the ICU. Cohort comparisons and the impact of the intervention on cost were assessed.

Results

The study matched 81 CRS/HIPEC procedures to form a cohort of 49 pre- and 15 post-intervention procedures for patients with similar disease burdens (mean PCI, 8 ± 6.7 vs. 7 ± 5.1). The pre-intervention patients stayed a median of 1 day longer in the ICU (1 day [IQR, 1–1 day] vs. 0 days [IQR, 0–0 days]) and had a longer LOS (8 days [IQR, 7–11 days] vs. 6 days [IQR, 5.5–9 days]). Complications and complication severity did not differ statistically. The median total hospital cost was lower after intervention ($30,845 [IQR, $30,181–$37,725] vs. $41,477 [IQR, $33,303–$51,838]), driven by decreased indirect fixed cost ($8984 [IQR, $8643–$11,286] vs. $14,314 [IQR, $12,206–$18,266]). In a weighted multiple variable linear regression analysis, the intervention was associated with a savings of $2208.68 per patient.

Conclusions

Selective admission to the IMC after CRS/HIPEC was associated with $2208.68 in savings per patient without added risk. In this era of cost-conscious practice of medicine, these data highlight an opportunity to decrease cost by more than 5% for patients undergoing CRS/HIPEC.

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Acknowledgements

We thank Deborah Lemaster for her assistance in data abstraction. The research reported in this publication was supported by the National Institute of Environmental Health Sciences (NIEHS) (National Institutes of Health Award no. 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, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Patrick B. Schwartz MD, Christopher C. Stahl MD, Roberto J. Vidri MD, MPH, Glen E. Leverson PhD, Yana Puckett MD, MBA, MS, MPH, Syed N. Zafar MD, MPH, Patrick Varley MD, MS, Sean M. Ronnekleiv-Kelly MD, Sharon M. Weber MD & Daniel E. Abbott MD

  2. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Ahmed Al-Niaimi 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 Patrick B. Schwartz MD.

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10434_2022_11967_MOESM1_ESM.docx

Supplemental Table 1: Secondary Analysis with the Addition of Operative Time to the Weighted Multiple Variable Linear Regression (DOCX 13 kb)

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Schwartz, P.B., Stahl, C.C., Vidri, R.J. et al. Rethinking Routine Intensive Care After Cytoreductive Surgery With Heated Intraperitoneal Chemotherapy: The Fiscal Argument. Ann Surg Oncol 29, 6606–6614 (2022). https://doi.org/10.1245/s10434-022-11967-6

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