title: A comparison of the hospital costs of open vs. minimally invasive surgical management of necrotizing pancreatitis.
abstract: BACKGROUND
  Infected necrotizing pancreatitis is a major burden for both the patient and the health care system. Little is known about how hospital costs break down and how they may have shifted with the increasing use of minimally invasive techniques. The aim of this study was to analyse inpatient hospital costs associated with pancreatic necrosectomy.
  
  
  METHODS
  A prospective database was used to identify all patients who underwent an intervention for necrotizing pancreatitis. Costs of treatment were calculated using detailed information from the Decision Support Department. Costs for open and minimally invasive surgical modalities were compared.
  
  
  RESULTS
  Twelve open and 13 minimally invasive necrosectomies were performed in a cohort of 577 patients presenting over a 50-month period. One patient in each group died in hospital. Overall median stay was 3.8 days in the intensive care unit (ICU) and 44 days on the ward. The median overall treatment cost was US$ 56,674. The median largest contributors to this total were ward (26.3%), surgical personnel (22.3%) and ICU (17.0%) costs. These did not differ statistically between the two treatment modalities.
  
  
  CONCLUSIONS
  Pancreatic necrosectomy uses considerable health care resources. Minimally invasive techniques have not been shown to reduce costs. Any intervention that can reduce the length of hospital and, in particular, ICU stay by reducing the incidence of organ failure or by preventing secondary infection is likely to be cost-effective.
authors.affiliation: Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Edwin
authors.initials: E
authors.lastname: Beenen
authors.forename: Lisa
authors.initials: L
authors.lastname: Brown
authors.forename: Saxon
authors.initials: S
authors.lastname: Connor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D016208:Databases, Factual / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000401:mortality; D009102:Multiple Organ Failure / Q000191:economics / Q000401:mortality; D010180:Pancreatectomy / Q000191:economics* / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D055815:Young Adult