Ann Surg Treat Res.  2017 Feb;92(2):73-81. 10.4174/astr.2017.92.2.73.

The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital

• Kim H
• Chung JK
• Ahn YJ
• Lee HW
• Jung IM

• KMID: 2367919
• DOI: http://doi.org/10.4174/astr.2017.92.2.73

Abstract

PURPOSE
Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD.
METHODS
From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status.
RESULTS
The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6-137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%.
CONCLUSION
Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.

Keyword

Pancreaticoduodenectomy; Municipal hospitals; Postoperative complications; Mortality; Hospital costs

MeSH Terms

Health Personnel
Hospital Costs
Hospital Mortality
Hospitals, Municipal*
Humans
Insurance Coverage
Length of Stay
Local Government
Mortality
National Health Programs
Pancreatic Fistula
Pancreaticoduodenectomy*
Postoperative Complications
Public Health
Retrospective Studies
Seoul
United States

Figure

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  Fig. 1 National Health Insurance Operation System (NHIS) of Korea (http://www.nhis.or.kr). HIRA, Health Insurance Review & Assessment Service.

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  Fig. 2 Annual change of pancreaticoduodenectomy cases in this hospital. Annual pancreaticoduodenectomy case in this hospital has been consistently increasing and reached to average 14 cases annually, ranging from 4 to 25.

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  Fig. 3 The 5-year survival rate of pancreatic head cancer.

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  Fig. 4 Comparison of the proportion of medical aid patients between this hospital and national data In comparison with the reported data of South Korea, the proportion of medical aid beneficiaries in this hospital was significantly higher than that of other hospitals in our country. SMG-SNU, Seoul Metropolitan Government-Seoul National University Boramae Medical Center. *Kim, et al. World J Gastroenterol 2012;18:4175-81 [1].

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  Fig. 5 Composition of mean cost of health care service per one patient who have undergone pancreaticoduodenectomy in this hospital. The mean of total cost was 16,583,755 Korean won (KRW) (13,819 United States dollar [USD]). Total National Health Insurance Operation System (NHIS) payment 13,243,315 KRW (11,036 USD) which occupied 79.8% of total cost was made up of both payment from NHIS (12,409,315 KRW [10,341 USD], 74.8%) and patient's copayment (834,000 KRW [695 USD], 5%). And actual burden to the patients was both patient's copayment in NHIS payment (834,000 KRW [695 USD], 5%) and non-NHIS payment (3,339,629 KRW [2,783 USD], 20.1%), reaching 4,173,636 KRW (3,478 USD) (25.1%).

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