Surgical Cost of Care in Crohn’s Disease

• Authors: Deborah S. Keller , Jeffry Katz , Sharon L. Stein , Conor P. Delaney
• Languages of publication: EN

Abstracts

EN

The aim of the studywas to evaluate the cost of surgical care and short-term outcomes of Crohn’s disease(CD) in the era of laparoscopy and biologic therapy. Material and methods. Review of a prospective database identifiedCD patients that underwent surgical management. Patients were stratified into laparoscopic, open, and converted approaches. Main outcome measures were short-term patient outcomes and cost of care by approach. Results. 92 patients were analyzed- 63.1% laparoscopic, 32.6% open, 4.3% converted. The majority was elective (100% converted, 94.8% laparoscopic, 90% open) and segmental resections (75% converted, 70.7% laparoscopic, 43.3% open). Operative times were similar between laparoscopic and open (152 minutes and 138 minutes, respectively). More open patients required ICU care (20% versus 12.1% laparoscopic and 0% converted). The median LOS was 3 (1-25) days laparoscopic, 4 (1-29) open and 4 (3-8) converted. The laparoscopic complication rate was 15.5%, readmission rate 12.1%, and reoperation rate 8.6%. The mean total hospital cost was $9,702 laparoscopic, $10,782 open, and $13,293 for converted cases (US Dollars). Conclusions. Laparoscopy is appropriate for most CD cases. When necessary to combine with open surgery, this results in efficient and effective patient outcomes and healthcare utilization. These results are important when weighing the cost of ongoing medical therapy versus surgical intervention.

Keywords

EN

Crohn’s disease; cost of treatment; surgical management; biologic therapy

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2013
• Volume: 85
• Issue: 9
• Pages: 511-516

Dates

published

1 - 09 - 2013

online

15 - 10 - 2013

Contributors

author

Deborah S. Keller

• Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio

author

Jeffry Katz

• Division of Gastroenterology, Department of Medicine, University Hospitals-Case Medical Center, Cleveland, Ohio

author

Sharon L. Stein

• Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio

author

Conor P. Delaney

• Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio

References

• 1. Buchner AM, Blonski W, Lichtenstein GR: Update on the management of Crohn’s disease. CurrGastroenterol Rep 2011; 13(5): 465-74.
• 2. Loftus EVJ: Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 2004; 126(6): 1504-17.[Crossref][PubMed]
• 3. Ananthakrishnan AN , McGinley EL, Binion DG,Saeian K: A nationwide analysis of changes in severity and outcomes of inflammatory bowel disease hospitalizations. J Gastrointest Surg 2011; 15(2): 267-76.[PubMed][Crossref][WoS]
• 4. Nguyen GC, Tuskey A, Dassopoulos T et al.: Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004. Inflamm Bowel Dis 2007; 13(12): 1529-35.
• 5. Cohen RD, Larson LR, Roth JM et al.: The cost of hospitalization in Crohn’s disease. Am J Gastroenterol 2000; 95(2): 524-30.[Crossref][PubMed]
• 6. Feagan BG, Vreeland MG, Larson LR, Bala MV: Annual cost of care for Crohn’s disease: a payor perspective. Am J Gastroenterol 2000; 95(8): 1955-60.[Crossref][PubMed]
• 7. Doherty GA, Miksad RA , Cheifetz AS , Moss AC: Comparative cost-effectiveness of strategies to prevent postoperative clinical recurrence of Crohn’s disease. Inflamm Bowel Dis 2012; 18(9): 1608-16.[PubMed][Crossref][WoS]
• 8. Bassi A, Dodd S, Williamson P, Bodger K: Cost of illness of inflammatory bowel disease in the UK: a single centre retrospective study. Gut 2004; 53(10): 1471-78.[PubMed][Crossref]
• 9. Bernstein CN, Nabalamba A: Hospitalization, surgery, and readmission rates of IBD in Canada: a population-based study. Am J Gastroenterol 2006; 101(1): 110-18.[Crossref]
• 10. Benedini V, Caporaso N, Corazza GR et al.: Burden of Crohn’s disease: economics and quality of life aspects in Italy. Clinicoecon Outcomes Res 2012; 4: 209-18.[PubMed]
• 11. Lichtenstein GR, Hanauer SB , Sandborn WJ: Management of Crohn’s disease in adults. Am JGastroenterol 2009; 104(2): 465-83; quiz 464, 484.[Crossref]
• 12. Lichtenstein GR, Yan S, Bala M et al.: Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology 2005; 128(4): 862-69.[Crossref]
• 13. Eshuis EJ, Bemelman WA , van Bodegraven AA et al.: Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn’s disease: a randomized multicenter trial (LIR!C-trial). BMCSurg 2008; 8: 15.
• 14. Travis SP, Stange EF, Lemann M et al.: European evidence based consensus on the diagnosis and management of Crohn’s disease: current management. Gut 2006; 55 Suppl 1: i16-35.[Crossref][WoS]
• 15. Steele SR : Operative management of Crohn’s disease of the colon including anorectal disease. Surg Clin North Am 2007; 87(3): 611-31.[WoS][Crossref][PubMed]
• 16. Gardiner KR , Dasari BV: Operative management of small bowel Crohn’s disease. Surg ClinNorth Am 2007; 87(3): 587-610.[Crossref]
• 17. Msika S, Iannelli A, Deroide G et al.: Can laparoscopy reduce hospital stay in the treatment of Crohn’s disease? Dis Colon Rectum 2001; 44(11): 1661-66.[Crossref]
• 18. Maartense S, Dunker MS, Slors JF et al.: Laparoscopic- assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg 2006; 243(2): 143-49; discussion 150-53.[Crossref]
• 19. Rosman AS , Melis M, Fichera A: Metaanalysis of trials comparing laparoscopic and open surgery for Crohn’s disease. Surg Endosc 2005; 19(12): 1549-55.[Crossref][PubMed]
• 20. McLeod RS : Surgery for inflammatory bowel diseases. Dig Dis 2003; 21(2): 168-79.[PubMed][Crossref]
• 21. Eshuis EJ, Polle SW , Slors JF et al.: Long-term surgical recurrence, morbidity, quality of life, and body image of laparoscopic-assisted vs. open ileocolic resection for Crohn’s disease: a comparative study. Dis Colon Rectum 2008; 51(6): 858-67.[WoS][Crossref][PubMed]
• 22. Alabaz O, Iroatulam AJ, Nessim A et al.: Comparison of laparoscopically assisted and conventional ileocolic resection for Crohn’s disease. Eur JSurg 2000; 166(3): 213-17.
• 23. Delaney CP: Operative techniques in laparoscopic colorectal surgery. Lippincott Williams & Wilkins 2007.[PubMed]
• 24. Delaney CP, Zutshi M, Senagore AJ et al.: Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. DisColon Rectum 2003; 46(7): 851-59.
• 25. Delaney CP: Outcome of discharge within 24 to 72 hours after laparoscopic colorectal surgery. DisColon Rectum 2008; 51(2): 181-85.
• 26. Delaney CP, Brady K, Woconish D et al.: Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways. AmJ Surg 2012; 203(3): 353-55; discussion 355-56.
• 27. Cohen RD: The cost of Crohn’s disease: drugs or surgery? BioDrugs 2000; 14(5): 331-44.[PubMed][Crossref]
• 28. Maggiori L, Panis Y: Laparoscopic approach for inflammatory bowel disease surgical managment. Acta Chir Iugosl 2012; 59(2): 75-79.[PubMed][Crossref]
• 29. Nguyen SQ, Teitelbaum E, Sabnis AA et al.: Laparoscopic resection for Crohn’s disease: an experience with 335 cases. Surg Endosc 2009; 23(10): 2380-84.[Crossref]
• 30. Tan JJ, Tjandra JJ: Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum 2007; 50(5): 576-85.[PubMed][Crossref]
• 31. Milsom JW, Hammerhofer KA , Bohm B et al.: Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum 2001; 44(1): 1-8; discussion 8-9.[Crossref]
• 32. Rosenthal RJ, Bashankaev B, Wexner SD: Laparoscopic management of inflammatory bowel disease. Dig Dis 2009; 27(4): 560-64.[Crossref][WoS][PubMed]
• 33. Young-Fadok TM, HallLong K, McConnell EJ et al.: Advantages of laparoscopic resection for ileocolic Crohn’s disease. Improved outcomes and reduced costs. Surg Endosc 2001; 15(5): 450-54.[Crossref]
• 34. Bodger K: Cost of illness of Crohn’s disease. Pharmacoeconomics 2002; 20(10): 639-52.[PubMed][Crossref]
• 35. Delaney CP, Kiran RP, Senagore AJ et al.: Quality of life improves within 30 days of surgery for Crohn’s disease. J Am Coll Surg 2003; 196(5): 714-21.

Identifiers

DOI

10.2478/pjs-2013-0079