Peritoneal Surface Malignancies
Yusuf Ciftci, BS
Medical Student
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Yusuf Ciftci, BS
Medical Student
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Yusuf Ciftci, BS
Medical Student
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Shannon N. Radomski, MD (she/her/hers)
Resident Physician
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Blake Johnson, BS
Medical Student
Johns Hopkins University School of Medicine, United States
Fabian M. Johnston, MD, MHS
Associate Professor of Surgery
Division of Gastrointestinal Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
Baltimore, Maryland, United States
Jonathan B. Greer, MD
Assistant Professor of Surgery
Johns Hopkins University School of Medicine, United States
Although there is conflicting evidence regarding the impact of increased anesthesia handoffs on patient outcomes, some studies show that a higher number of handoffs lead to increased length of stay and delayed extubation in patients. In turn, these factors can lead to higher healthcare costs for patients and hospitals. There are no studies investigating the relationship between intraoperative anesthesia handoffs and cost of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIEPC). As such, this study aims to determine the impact of anesthesia handoffs on cost of this procedure.
Methods: We performed a retrospective cohort study of patients undergoing CRS-HIPEC from 2016-2022 at a single quaternary center. We performed 1:1 propensity score matching to adjust for patient complexity and the following covariates: ASA class, operative time, estimated blood loss, PCI, ostomy, intraoperative transfusion. Patients were divided into cohorts based on number of handoffs (0-1 vs. >1). The Mann-Whitney U test and was used to compare continuous variables and χ2 test to compare categorical variables.
Results: Our final matched cohort consisted of 78 patients, with 39 patients in each cohort. After adjusting for patient complexity and inflation, there was no significant difference between total cost (0-1 Handoffs $105,706 [$87,385-$139-315] vs. >1 Handoffs $113,218 [$92,199-$159,981], p=0.576) and operating room cost ($38,381 [$33,042-$43,301] vs. $41,591 [$34,287-$50,463], p=0.128) between the two cohorts. Length of stay (12 days [IQR 9.5-20.5 days] vs. 13 days [IQR 11-17.5 days], p=0.589), overall post operative complications (n=25, 64% vs. n=25, 64%, p=0.999), and serious complications (n=15, 38% vs. n=11, 28%, p=0.453) were also similar between the cohorts. There was an estimated $5,111 (SE $2,858, 95% CI [$492-$10,711], p=0.074) increase in operating room cost with >1 anesthesia handoffs, though this was not statistically significant (p=0.074) (Table 1).
Conclusions:
A higher number of anesthesia handoffs during CRS-HIPEC does not increase cost, worsen outcomes, or increase length of stay. Thus, anesthesia handoffs are not a significant driver of cost in CRS-HIPEC.