University of Wisconsin, Department of Surgery, Madison, Wisconsin; University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, New York.
University of Wisconsin, Department of Surgery, Madison, Wisconsin.
J Surg Res. 2022 Sep;277:244-253. doi: 10.1016/j.jss.2022.04.010. Epub 2022 Apr 30.
The minimally invasive step-up approach to pancreatitis improves outcomes. Multidisciplinary working groups may best facilitate this approach. However, support for these working groups requires funding. We hypothesize that patients requiring surgical debridement generate sufficient revenue to sustain these working groups. Furthermore, patients selected for surgical debridement by the working group will have a higher rate of percutaneous and endoscopic intervention in adherence to the step-up approach.
We conducted an observational cohort study of all patients with severe acute and/or necrotizing pancreatitis whose care was overseen by our multidisciplinary working group (October 2015 through January 2019). Patient demographics, hospital treatments, and outcomes data were compared between those who underwent surgical debridement and those who did not. Hospital billing data were also collected from those who are undergoing surgical debridement and compared to institutional benchmarks for financial sustainability.
A total of 108 patients received care overseen by the working group, 10 of which progressed to surgical debridement. The mean contribution margin percentages for each patient in the surgical debridement group were higher than the threshold value for financial sustainability, 39% (60.34% ± 16.66%; P = 0.004). Patients in the surgical debridement group were more likely to undergo intervention by interventional radiologist (odds ratio, 1.58; P = 0.005). The mortality was higher in the nonsurgical debridement group (odds ratio, 15; P = 0.008).
Our multidisciplinary working group delivered step-up care to patients with pancreatitis. Patients requiring surgical debridement generated a significantly positive contribution margin that could be used to help support the costs associated with providing multidisciplinary care.
微创逐步升级方法治疗胰腺炎可改善预后。多学科工作组可能是促进这种方法的最佳选择。然而，这些工作组的支持需要资金。我们假设需要手术清创的患者可以产生足够的收入来维持这些工作组的运作。此外，工作组选择进行手术清创的患者将有更高的经皮和内镜介入率，以遵循逐步升级的方法。
我们对所有由我们的多学科工作组监督的患有严重急性和/或坏死性胰腺炎的患者进行了观察性队列研究（2015 年 10 月至 2019 年 1 月）。比较了接受手术清创和未接受手术清创的患者的人口统计学、医院治疗和结局数据。还从正在接受手术清创的患者中收集了医院计费数据，并与机构的财务可持续性基准进行了比较。
共有 108 名患者接受了工作组的治疗，其中 10 名患者进展为手术清创。手术清创组每位患者的平均贡献利润率百分比高于财务可持续性的阈值，为 39%（60.34%±16.66%；P=0.004）。手术清创组的患者更有可能接受介入放射学家的干预（比值比，1.58；P=0.005）。非手术清创组的死亡率更高（比值比，15；P=0.008）。
我们的多学科工作组为胰腺炎患者提供了逐步升级的治疗。需要手术清创的患者产生了显著的正贡献利润率，可用于帮助支持提供多学科护理的相关成本。
