A Pilot Comparison of Outcomes and Costs for Antegrade Colonic Enema Surgery in Pediatric Patients
Andrea J. Moyer, BS, Zachary J. Prebay, MD, Jonathan S. Ellison, MD, Travis W. Groth, MD, John V. Kryger, MD, Elizabeth B. Roth, MD.
Children's Wisconsin, Milwaukee, WI, USA.
BACKGROUND: Minimally invasive approaches to Malone Antegrade Colonic Enema (MACE) channel creation have been developed without data evaluating such innovations to date. To better understand differences between various approaches, we piloted a comparison of open, hybrid laparoscopic- open (LO) and robotic-assisted (RA) MACE in terms of cost and perioperative outcomes.
METHODS: Pediatric patients (<18 years) undergoing open, LO and RA MACE surgery at a single pediatric tertiary center from 3/6/2013 to 12/31/2019 were included. Patients with simultaneous bladder conduits were included while simultaneous bladder augmentation was excluded. Baseline characteristics and perioperative outcomes were assessed including length of stay (LOS), estimated blood loss (EBL), days until return of diet, prior or simultaneous procedures and intraoperative or 30 day postoperative complications. Hospital costs and patient charges were calculated in terms of direct variable cost component based on Operating Room (OR) time, OR supplies and inpatient recovery measured in US dollars (2020). ANOVA or Fisher’s exact tests were performed for continuous and categorical variables with significance considered at p<0.05. RESULTS: In total, 14, 18 and 12 patients underwent open, LO and RA surgery with no significant differences in age, body mass index, gender or surgical history between the groups. 20 (45%) patients underwent a simultaneous procedure, 15 (34%) of which included bladder conduits. RA patients were less likely to undergo a simultaneous procedure (p<0.01). No difference in intra- or post-operative complications were noted between groups. RA was associated with lower LOS compared to both Open and LO, days until return of diet compared to LO, and EBL compared to Open (Table 1). RA total cost for the hospital was greatest but with less charges billed to patients (Table 1). CONCLUSIONS: This pilot study showed RA MACE may offer select clinical advantages with less charged to patients but was more expensive to the hospital. Patient selection may confound comparisons. However, the shorter length of stay may influence parental preference and should be considered during shared decision making. Further multi-institutional work with a larger sample size will help to validate these findings.
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