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Improved Quality of Care and Efficiency Do Not Always Mean Cost Recovery After Minimally Invasive Ivor Lewis Esophagectomy.

Authors
  • Pather, Keouna1
  • Ravindran, Krishnan1
  • Guerrier, Christina2
  • Esma, Rhemar1
  • Kendall, Heather1
  • Hacker, Shoshana1
  • Awad, Ziad T3
  • 1 UF Health-Jacksonville, Jacksonville, FL, USA.
  • 2 Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
  • 3 Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA. [email protected]
Type
Published Article
Journal
Journal of Gastrointestinal Surgery
Publisher
Springer-Verlag
Publication Date
Nov 01, 2021
Volume
25
Issue
11
Pages
2742–2749
Identifiers
DOI: 10.1007/s11605-021-04931-4
PMID: 33528787
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The aim of this study is to determine the financial impact of clinical complications and outcomes after minimally invasive Ivor Lewis esophagectomy (MILE) at a safety-net hospital. This was a single-center retrospective analysis of consecutive patients undergoing MILE from 2013 to 2018. Postoperative complications were classified by Clavien-Dindo grade and associated total and direct recovered costs were assessed. Direct cost and LOS index were defined as the ratio of observed to expected values (>1 denotes above nationwide expectations). Annual outcomes were based on Medicare fiscal years. One hundred twenty-four patients (99 males, mean age 65.7 ± 9.3) were surgically treated for esophageal malignancy (n = 118) and benign disease (n = 6) by MILE between 2014 and 2018. Mean ICU LOS (5.8 ± 6.6 versus 4.3 ± 6.3 days) and LOS index (1.16 versus 0.76) improved from 2014 to 2018. Both direct cost index (1.03 versus 0.99) and indirect costs (43.4% versus 41.4%) decreased over time. However, direct costs recovered (213.6 to 159.0%) and total costs recovered (119.1 to 92.5%) declined during this period. Clinical complications grade was not associated with total costs recovered (p = 0.69). Extent of recovered expenditure was significantly higher from commercial/private payers as compared to government-sponsored payers (p < 0.05). Improvement in clinical outcomes and efficiency of care are not reflected by annual recovered expenditure. Furthermore, clinical complications do not correlate with the ability to recover hospital spending. Financial recovery was primary payer dependent. Enhanced collaboration with hospital administration may be needed in an effort to maximize financial fidelity in the presence of good quality of care after highly complex procedures. © 2021. The Society for Surgery of the Alimentary Tract.

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