Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Surgery, Isala Hospital, Zwolle, The Netherlands.
BJS Open. 2022 Sep 2;6(5). doi: 10.1093/bjsopen/zrac109.
The aim of this study was to evaluate the impact of all minor and major complications on treatment-related healthcare costs in patients who undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of colorectal peritoneal metastases (PMs).
Patients with histologically proven colorectal PMs who underwent CRS + HIPEC from March 2006 to October 2019 in a tertiary referral centre were retrospectively identified from a prospectively maintained database. Patients were divided into six subgroups according to the severity of the complications, which were scored using the comprehensive complication index (CCI) (CCI 0-9.9, CCI 10-19.9, CCI 20-29.9, CCI 30-39.9, CCI 40-49.9, and CCI 50 or higher). Treatment-related healthcare costs up to 1 year after CRS + HIPEC were obtained from the financial department. Differences in costs and survival outcomes were compared using the chi-squared test and Kruskal-Wallis H test.
A total of 142 patients were included (CCI 0-9.9, 53 patients; CCI 10-19.9, 0 patients; CCI 20-29.9, 45 patients; CCI 30-39.9, 14 patients; CCI 40-49, 9 patients; and CCI 50 or higher, 21 patients). Median (interquartile range) treatment-related healthcare costs increased significantly and exponentially for the CCI 30-39, CCI 40-49, and CCI 50 or higher groups (€48 993 (€44 262-€84 805); €57 167 (€43 047-€67 591); and €82 219 (€55 487-€145 314) respectively) compared with those for the CCI 0-9.9 and CCI 20-29.9 groups (€33 856 (€24 433-€40 779) and €40 621 (€31 501-€58 761) respectively, P < 0.010).
Treatment-related healthcare costs increase exponentially as more complications develop among patients who undergo CRS + HIPEC for the treatment of colorectal PMs. Anastomotic leakages after CRS + HIPEC lead to an increase of 295 per cent of treatment-related healthcare costs.
本研究旨在评估在接受细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）治疗结直肠腹膜转移（PMs）的患者中，所有轻微和严重并发症对与治疗相关的医疗保健费用的影响。
从一个前瞻性维护的数据库中回顾性地确定了 2006 年 3 月至 2019 年 10 月期间在一家三级转诊中心接受 CRS+HIPEC 治疗的组织学证实的结直肠 PM 患者。根据并发症的严重程度将患者分为六个亚组，使用综合并发症指数（CCI）（CCI 0-9.9、CCI 10-19.9、CCI 20-29.9、CCI 30-39.9、CCI 40-49.9 和 CCI 50 或更高）进行评分。从财务部门获得 CRS+HIPEC 后 1 年内与治疗相关的医疗保健费用。使用卡方检验和 Kruskal-Wallis H 检验比较成本和生存结果。
共纳入 142 例患者（CCI 0-9.9，53 例；CCI 10-19.9，0 例；CCI 20-29.9，45 例；CCI 30-39.9，14 例；CCI 40-49，9 例；CCI 50 或更高，21 例）。CCI 30-39、CCI 40-49 和 CCI 50 或更高组的与治疗相关的医疗保健费用中位数（四分位距）显著且呈指数增长（€48993（€44262-€84805）；€57167（€43047-€67591）；€82219（€55487-€145314）），与 CCI 0-9.9 和 CCI 20-29.9 组相比（€33856（€24433-€40779）和€40621（€31501-€58761），P<0.010）。
在接受 CRS+HIPEC 治疗结直肠 PM 的患者中，并发症越多，与治疗相关的医疗保健费用呈指数增长。CRS+HIPEC 后的吻合口漏会导致与治疗相关的医疗保健费用增加 295%。
