Search

It has been demonstrated that mortality following pancreatectomy is correlated with surgical volume. However, up until now, no French study has focused on predictive factors to undergo pancreatectomy in low-volume centers. The objective of this study is to analyze the clinical characteristics, socio-economic status and medical density according to surgical volume and to analyze predictive factors for undergoing pancreatectomy in low-volume centers. All patients who underwent pancreatectomy in France from 2012 to 2015 were identified fromthe PMSI database. Hopsitals were classified as low, intermediate and high volume (< 10, 11–19, ≥ 20 resections/year, respectively). Clinical and socioeconomic data, travel distance and rurality were assesed to identify factors associated with undergoing pancreatectomy at low-volume hospitals. In overall, 12,333 patients were included. Those who underwent pancreatectomy in low-volume centers were more likely older, had high Charlson comorbidity index (CCI), had low socioeconomic status, and resided in rural locations.distance traveled by patients operated on in low-volume centers was significantly shorter (23 vs. 61 km, P < 0.001). In multivariable analysis, older age (P = 0.04), CCI ≥ 4 (P = 0.008), short travel distance (P < 0.001), low socio-economic status (P < 0.001) and rurality (P < 0.001) were associated withundergoing pancreatectomy in low-volume centers. Patients continue to undergo pancreatectomy at low-volume hospitals is due not only to clinical parameters, but also to socioeconomic and environmental factors. These factors should be taken into account in process of pancreatic surgery centralization. [ABSTRACT FROM AUTHOR]

Summary Objective To define the cost of pancreatectomies and to identify factors associated with increased hospital costs after pancreatic resection. Methods All patients undergoing pancreatic surgery in our department between January 2008 and December 2014 were included. All complications occurring during hospitalization or in the 90-day period after discharge were documented. The hospital costs were analyzed and predictive factors of increased hospital costs were determined. Results One hundred and twenty seven patients were identified. Most patients underwent pancreatectomy for malignant tumors (70%). Median hospital costs were 21,392 [15,998–29,667] euros. Age (P = 0.011) and preoperative jaundice (P < 0.001) were associated with higher hospital costs. Intraoperative surgical time and blood loss were correlated with increased costs (P = 0.001 and P = 0.002, respectively). Pancreatoduodenectomy was associated with statistically significantly higher costs compared to distal pancreatectomy (21,770 vs. 15,422 euros, P = 0.001). Severe postoperative complications (Clavien-Dindo grade ≥ 3) (P = 0.001), septic complications (P = 0.002) and hemorrhage (P = 0.001) statistically significantly increased costs. In multivariate analysis, septic (P = 0.003) and severe complications (P = 0.01) were statistically significantly associated with increased hospital costs. Conclusion Pancreatic surgery is associated with high hospital costs, essentially related to postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract: Varicella is a universal childhood disease in Spain, causing approximately 400,000 cases, 1500 hospitalizations and 15 deaths every year. The aim of this study is to determine the economic impact of childhood varicella vaccination on the burden of disease and associated costs by using a dynamic model. The analysis is based on the varicella transmission model developed by Halloran and adapted to the Spanish context. Cost data (€, 2004) were derived from previous studies and official tariffs. Two vaccination scenarios were analysed: (1) routine vaccination program for children aged 1–2 years, and (2) routine vaccination program for children aged 1–2 years completed by a catch-up program during the first year of vaccine marketing for children aged 2–11 years. The analysis considers that a similar coverage rate to the MMR one would be achieved (97.15%). A societal perspective, including direct and indirect costs, and a health care payor perspective were adopted. A probabilistic sensitivity analysis was performed. A routine vaccination program has a positive impact on varicella-related morbidity: the number of varicella cases is estimated to be reduced by 89%, and 1230 hospitalizations are prevented. From the societal perspective, scenario (1) is cost-saving whether or not indirect costs are considered (−51 and −4%, respectively). From the Health Care System the strategy is cost-effective, with a cost-effectiveness ratio estimated at €3982 per life-year gained, although it leads to a small increase in the costs. Considering the impact of vaccination on morbidity and costs, a routine childhood vaccination program against varicella is worth while in Spain without taking into account the potential impact on HZ. [Copyright &y& Elsevier]

B Background: b No recent study has investigated the impact of hospital volume (HV) on hospital mortality (HM) of pancreatic surgery according to Charlson Comorbidity Index (ChCI).The objective was to identify the impact of HV according to ChCI on HM in pancreatic surgery. The 90 day HM were 1.9 and 1.5-fold increased in very low (9.1% vs 4.8%, p<0.001) and low HV (8.1% vs 4.8%, p<0.001) in comparison with high HV respectively, while there was no difference between intermediate and high HV centers (5.8% vs 4.8%, p=0.08). For low risk patients (ChCI:0-2), 90 day HM was significantly higher in low and very low HV compared to intermediate and high HV centers (6.1%, 6.2% vs 3.7, 3.3%, p<0.001). [Extracted from the article]

Introduction et but de l’étude L’utilisation de verrous de taurolidine au long cours (VTLC) semble être efficace dans la prévention secondaire des infections liées aux cathéters (ILC) veineux centraux. L’objectif de ce travail était d’évaluer l’efficacité de cette pratique chez les patients adultes recevant une Nutrition Parentérale à Domicile (NPAD). Matériel et méthodes Cette étude a été réalisée chez les patients adultes d’un centre agréé de NPAD. À partir du 1 er juillet 2011, les VTLC ont été instaurés au décours du troisième épisode d’ILC survenant en moins de 12 mois. Le nombre d’ILC prouvées et d’ILC probables, de changements de cathéters, le nombre et la durée des séjours en hospitalisation conventionnelle en rapport avec une ILC ont été recueillis prospectivement depuis l’initiation des VTLC et ce jusqu’à la date de point du 1 er juillet 2013. Pour chaque patient, la durée de ce recueil déterminait la durée de recueil rétrospective de ces mêmes données avant que ne soient initiés les VTLC, de sorte que les temps de recueil avant et après initiation des VTLC étaient identiques. Les analyses statistiques ont été réalisées par une méthode de bootstrap non paramétrique sur séries appariées, avec un seuil de significativité de 1 %. Résultats et Analyse statistique Les données de 37 patients, âgés en moyenne de 56 ± 17 ans et ayant reçu les VTLC pendant 13,8 ± 7,8 mois ont été analysés. En cas d’ILC prouvée, l’instauration des VTLC permettait d’observer une diminution : du taux d’ILC (passant de 3,18 à 0,39 /1000 jours cathéters, p < 0,0001), du taux de remplacement des cathéters (de 0,83 à 0,07 /1000 jours cathéters, p = 0,0006), du nombre de séjours (de 32 à 4, p < 0,0001) et de leur durée totale (de 267 à 77 j, p = 0,0137). Ces diminutions étaient également significatives lorsqu’on additionnait les ILC prouvées et probables (8,21 à 0,74 /1000 jours cathéters, p < 0,0001; 1,79 à 0,15/1000 jours cathéters, p < 0,0001 ; 71 à 8, p < 0,0001; 677 à 133 j, p < 0,0001). Après l’instauration des VTLC, la durée moyenne des séjours était comparable à celles constatées avant en cas d’ILC prouvée (10,8 vs 9,41 ; p = 0,3125) mais elle diminuait lorsqu’on leur additionnait les ILC probables (8,27 vs 3,26 ; p = 0,0047). Conclusion Il s’agit à notre connaissance de la plus large cohorte étudiée, en prévention secondaire. L’utilisation de la nouvelle stratégie liée au VTLC semble réduire significativement la survenue d’ILC, et réduit le taux de remplacement des cathéters. Le nombre de séjour et la durée ayant diminuée, une évaluation médico-économique est en cours afin de déterminer le rapport coûtefficacité de cette nouvelle stratégie. [ABSTRACT FROM AUTHOR]