Oral (pre-recorded)
General HPB |
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| OG03 General HPB: Education |
Selection of Presentations from Abstract Submissions
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| 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.
| Diagnosis | Patient Number | Hospital Stay (Median: Range) | Median Cost per Patient Admission ($NZ) | | Interventional Radiology: Biopsy/Ablation | 67 | 2.4 days (1-4.7 days) | $29427 | | Interventional radiology: Drainage | 99 | 3.8 days (2-18.8 days) | $25899 | | Endoscopy: Diagnostic | 144 | 4.6 days (3.1-8.4 days) | $19594 | | Endoscopy: Therapeutic | 153 | 4.3 days (2.5-7.5 days) | $27439 | | Palliative Care | 78 | 8.9 days (4.1 - 29 days) | $12678 | | Symptom Management | 106 | 8.9 days (3.7- 10.6 days) | $14523 | | Other | 25 | 3.3 days (1- 5.9 days) | $6372 |
[Admission reason, hospital daystay and cost in patients managed with surgery] |
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