H. D. Mogal1, E. A. Levine1, N. F. Fino2, T. I. Fleming1, V. Getz1, P. Shen1, J. H. Stewart1, K. I. Votanopoulos1 1Wake Forest University School Of Medicine,Department Of Surgery, Division Of Surgical Oncology,Winston-Salem, NC, USA 2Wake Forest University School Of Medicine,Department Of Biostatistics,Winston Salem, NC, USA
Introduction: The financial considerations of admitting patients undergoing Cytoreductive surgery and Heated Intraperitoneal chemotherapy (CRS/HIPEC) routinely to the ICU for postoperative care have not been elucidated. Our aim was to study cost differences between patients admitted postoperatively to the ICU and floor and to assess if avoiding routine ICU admission in selected patients can minimize costs without compromising quality.
Methods: Single index-surgical encounter costs for patients admitted directly to the floor or to the ICU for less than 48 hours were retrospectively analyzed from a prospectively maintained institutional database of CRS/HIPEC patients between April 2012 and June 2014. Comparison of clinicopathological variables, complications and average costs between the groups was performed.
Results: 65 patients were observed in the ICU for less than 48 hours, while 51 patients were sent directly to the floor. The two groups were similar for race (p = 0.87), sex (p = 0.12), number of comorbidities (p = 0.17), primary site of tumor (p = 0.37) and ECOG status (p = 0.16). PCI (Peritoneal Cancer Index) score was higher for patients in the ICU (mean 15.6 ± 7.4) compared to those on the floor (mean 10.3 ± 8.1; p = 0.0006). Estimated blood loss (OR 1.26, p = 0.0075) and PCI scores (OR 1.12, p = 0.02) were independent risk factors for admission to ICU. For patients that were observed directly on the floor, average costs were $4460 less than for patients who were observed in the ICU for less than 48-hours ($15209 and $19669 respectively; p < 0.0001). Analysis between these two groups showed no significant difference in minor complications (p = 0.23) or major morbidity (p = 0.44).
Conclusion: Selective postoperative ICU admission is associated with a substantial reduction in cost and no increase in major or minor morbidity.