Oral (pre-recorded)
General HPB 
OG03 General HPB: Education 
Selection of Presentations from Abstract Submissions

OG03-02 Hidden in Plain Sight: Non-operative Work Is Now Core Business for Hepatopancreaticobiliary Unit
Jonathon Koea, New Zealand

J. Koea1, S. Srinivasa1, U. Leung1, M. Pimm2, M. Rodgers1
1Surgery, North Shore Hospital, New Zealand, 2North Shore Hospital, New Zealand

Introduction: Increasing use is now made of modalities other than surgery in the care of patients with hepatopancreaticobiliary (HPB) conditions. This includes endoscopy and interventional radiology, as well as admission for complex diagnostic workup, symptom control and palliative care. In spite of this change in practice the care of, and responsibility for, patients managed non-operatively continues to reside with surgical services.
Methods: Using a prospectively maintained database all admissions for the 2019 calendar year were reviewed and classified on acuity, patient demographics, diagnosis, hospital stay and whether operative intervention was performed. Standard tariffs set by our hospital's independent coding and costing committee, which adhere to national standards, were used to calculate cost of care.
Results: For 2019, 1098 patients were admitted to our HPB unit with 426 (38%) undergoing one or more operative procedures and 672 (62%) managed without operation. Patients admitted electively were more likely to undergo operation (318/617 elective admissions (51%)) than those admitted acutely (108/481 of acute admissions (22%)) and the likelihood of non-operative management increased with patient age at admission (45-64 years: RR 1.0; 85 + years 1.7 P< 0.05). Principle admission reason,
hospital stay and costs for non-operated patients are summarised in table 1.
Conclusion: Non-operative work comprises over half of the work and half the budget of the contemporary HPB unit and reflects the growing use of technologies other than surgery to manage patients. This has important implications for surgical training, unit benchmarking and accreditation which have historically emphasized surgical metrics.
DiagnosisPatient NumberHospital Stay (Median: Range)Median Cost per Patient Admission ($NZ)
Interventional Radiology: Biopsy/Ablation672.4 days (1-4.7 days)$29427
Interventional radiology: Drainage993.8 days (2-18.8 days)$25899
Endoscopy: Diagnostic1444.6 days (3.1-8.4 days)$19594
Endoscopy: Therapeutic1534.3 days (2.5-7.5 days)$27439
Palliative Care788.9 days (4.1 - 29 days)$12678
Symptom Management1068.9 days (3.7- 10.6 days)$14523
Other253.3 days (1- 5.9 days)$6372
[Admission reason, hospital daystay and cost in patients managed with surgery]