Cost analysis and outcome of endoscopic submucosal dissection for colorectal lesions in an outpatient setting.
Dig Liver Dis
; 51(3): 391-396, 2019 03.
Article
em En
| MEDLINE
| ID: mdl-30385079
ABSTRACT
BACKGROUND AND STUDY AIMS:
Endoscopic submucosal dissection (ESD), a minimally invasive treatment for early gastrointestinal (GI) cancer, is considered challenging and risky in the colorectum. As such, most patients undergoing ESD are hospitalized due to the perceived increased risk of adverse events. The aim of this study was to compare the costs, safety and efficacy of colorectal-ESD in an outpatient vs inpatient setting in a tertiary level center.METHODS:
This is a retrospective study on consecutive patients admitted for colorectal-ESD. Patients were divided into outpatients (Group-A, same-day discharge), and inpatients (Group-B, admitted for at least one night). Data on overall costs, outcomes and adverse events were assessed for each group.RESULTS:
A total of 136 patients were considered. Fourteen were excluded because ESD was not performed due to intraprocedural suspicion of invasive cancer. Eighty-three patients were treated as outpatients (Group-A, 68%) and 39 (Group-B, 32%) were hospitalized. R0-rate was 90.4% in Group-A and 89.7% in Group-B(Pâ¯=â¯0.98). One perforation occurred in Group-A (1.2%) and 2 in Group-B(5.1%, Pâ¯=â¯0.2). Mean Length of stay (LOS) was 1â¯day for outpatients and 3.3â¯days for inpatients. Management of Group-A as outpatients produced a cost savings of 941 on average per patient.CONCLUSIONS:
Outpatient colorectal-ESD is a feasible, cost-effective strategy to manage superficial colorectal tumors with outcomes comparable to inpatient colorectal-ESD. By using proper selection criteria, outpatient ESD could be considered the first-line approach for most patients.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Pacientes Ambulatoriais
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Neoplasias Colorretais
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Custos e Análise de Custo
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Ressecção Endoscópica de Mucosa
/
Pacientes Internados
Tipo de estudo:
Health_economic_evaluation
/
Observational_studies
/
Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Dig Liver Dis
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2019
Tipo de documento:
Article