Routine Intensive Care Unit Admission Following Liver Resection: What Is the Value Proposition?
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ORIGINAL ARTICLE
Routine Intensive Care Unit Admission Following Liver Resection: What Is the Value Proposition? Katiuscha Merath 1 & Marcelo Cerullo 2 & Ayesha Farooq 1 & Joseph K. Canner 3 & Jen He 3 & Diamantis I. Tsilimigras 1 & Rittal Mehta 1 & Anghela Z. Paredes 1 & Kota Sahara 1 & Mary Dillhoff 1 & Allan Tsung 1 & Jordan Cloyd 1 & Aslam Ejaz 1 & Timothy M. Pawlik 1 Received: 19 July 2019 / Accepted: 9 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Introduction The value of routine ICU admission after elective surgery has been debated due to the lack of robust evidence supporting its benefit, as well as the increased incurred costs. We sought to analyze outcomes of patients undergoing hepatectomy who were routinely admitted to the intensive care unit (ICU) compared with surgical ward admission. Methods Patients were identified in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database from 2010 to 2016. Routine postoperative ICU admission was defined as ICU admission for ≤ 24 h on postoperative day 0. Potential association between routine ICU admission with extended length-of-stay (LOS), failureto-rescue, and total inpatient costs was analyzed. Results In total 7970 patients underwent hepatectomy; 37.7% (n = 3001) had routine ICU admission and 62.3% (n = 4969) surgical ward admission. Among the 3001 patients who had routine ICU admission, 1137 (37.9%) had a major and 1864 (62.1%) had a minor hepatectomy. Routine ICU admission was not associated with lower failure-to-rescue (routine ICU 4.9% vs. ward 1.8%; p < 0.001). Patients routinely admitted to the ICU had longer median LOS (routine ICU 7 days, IQR 5–15 days vs. ward 5 days, IQR 4–7 days; p < 0.001). Median payments were higher for routine ICU admission than for surgical ward admission ($50,501, IQR $34,270–$80,459 vs. $39,774, IQR $28,555–$58,270, respectively). Conclusion Routine ICU admission was associated with longer LOS and higher hospital payments, yet did not translate into lower failure-to-rescue among patients undergoing hepatectomy. Keywords Mortality . Failure-to-rescue . Hepatectomy . Intensive care unit
Introduction In the era of value-based care, healthcare systems should strive to provide patients with high value care—i.e., highquality care at lower costs. Over the last decade, there have been a number of evidence-based quality initiatives aimed at reducing wasteful healthcare spending while
* Timothy M. Pawlik [email protected] 1
Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH 670, USA
2
Department of Surgery, Duke University, Durham, NC, USA
3
Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
improving the healthcare delivered to patients. 1 – 6 Increased focus on patient-centered care and patient safety has fostered enhanced recovery protocols that have challenged certain dogmatic practices in the perioperative management of patients undergoing complex surgery.7–9 One such practice is the r
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