E413: Projected Impact of a System-Wide Preoperative Nutrition Strategy for Foregut and Pancreatic Cancer Patients

Preoperative immune-modulation and carbohydrate loading have been shown to improve surgical outcomes. However, the implications of introducing a system-wide nutritional bundle remain unexplored. We aim to project the value implications of providing routine preoperative nutrition to a cohort of cancer surgery patients within an integrated cancer network.

Methods: We used administrative claims data to identify patients who underwent esophagectomy, gastrectomy, or pancreatectomy under a single insurance plan within a regional health system between July 1, 2020, and June 30, 2021. We determined the total healthcare utilization (HCU) associated with these procedures. Projections were adjusted to account for the anticipated number of surgeries performed within our cancer network in a year: 50 gastric, 75 esophageal, and 100 pancreatic. We conducted a comprehensive literature review to estimate the potential reduction in complications and length of stay (LOS) associated with the use of preoperative nutrition for these procedures. Outlier days, defined as hospital days exceeding 30, is a cost incurred by the payer. After considering the estimated costs of delivering nutrition to each patient, we project the comprehensive financial implications of the program.

Results:

The total projected HCU for these 225 procedures is $4,374,476. With a projected average LOS reduction of 18%, 220 total in-hospital days would be reduced, representing cost savings to the provider. With a subsequent decrease in 11 outlier days, this translates to a cost savings of $43,050 for the payer. Additionally, the projected reduction in complications would result in HCU savings of $74,660. As such, the projected cost savings for the payer from a system-wide preoperative nutrition program amount to $171,710 (see table). After accounting for the cost of direct delivery of the nutritional bundle to each patient (225 claims x $60 per bundle = $13,500), the total projected annual savings for the payer/insurance sector is $104,210. 

Conclusions:

Providing standardized delivery of preoperative nutrition to patients undergoing oncologic surgery offers improved outcomes and cost savings to both payers and providers within an integrated cancer network.