Appendix online-only tables
Table A1: List of procedures and complications for which search terms were produced
Surgical segment / Procedures / Surgical complications sought for burden dataHepatopancreaticobiliary /
- Hemihepatectomy or major liver resection
- Pancreaticojejunostomy
- Left (distal) pancreatectomy
- Whipple procedure
Urology /
- Partial nephrectomy
- Radical prostatectomy
Gynaecology /
- Endometriosis resection
- Hysterectomy
- Pelvic lymphadenectomy
Thoracic /
- Lobectomy (including bilobectomy)
- Atypic lung resection
- Mediastinal lymph node dissection
General /
- All above procedures
Table A2: Details of Medline search
Searches / Results1 / Cost benefit analysis/ / 54191
2 / Cost of illness/ / 15130
3 / Financial management/ / 15025
4 / Health care cost/ / 23216
5 / Hospital cost/ / 6853
6 / cost$.tw. / 304563
7 / (length and stay).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 68237
8 / (duration and stay).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 13840
9 / (resource adj3 us*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 6569
10 / hospitali*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 175950
11 / "Costs and Cost Analysis"/ / 39817
12 / emergency health service/ or emergency care/ / 29194
13 / (resource* adj3 utili*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 6334
14 / (resource* adj2 us*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 10466
15 / "length of stay"/ / 50773
16 / Outpatient Clinics, Hospital/ / 13745
17 / 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 / 622655
18 / exp postoperative complication/ / 384246
19 / expPeroperative Complication/ / 33253
20 / exp Intraoperative Complications/ / 33253
21 / complication$.mp. / 872239
22 / adverse event*.mp. / 60848
23 / 18 or 19 or 20 or 21 or 22 / 1031431
24 / bleeding/ / 47793
25 / abscess/ or subphrenic abscess/ or abdominal abscess/ or pelvis abscess/ or perirenal abscess/ / 24095
26 / wound infection/ or postoperative infection/ or surgical infection/ / 8765
27 / infection/ or urogenital tract infection/ or lung infection/ or hospital infection/ or lower respiratory tract infection/ or urinary tract infection/ or abdominal infection/ or secondary infection/ or biliary tract infection/ / 99729
28 / (abdominal adj2 collection).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 119
29 / injury/ or nerve injury/ or nervous system injury/ or surgical injury/ / 82756
30 / anemia/ / 30951
31 / atelectasis/ / 5296
32 / bacteremia/ / 15659
33 / intestine injury/ or bowel injury.mp. / 743
34 / fluid collection.mp. or abdominal abscess/ / 3419
35 / empyema/ / 3352
36 / wound dehiscence/ or anastomosis dehiscence/ or dehiscence.mp. / 11150
37 / (nerve adj3 injur*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 21355
38 / hemoperitoneum/ / 2635
39 / lymphocele.mp. / 1094
40 / lymphocyst.mp. / 123
41 / lymphorrhea.mp. / 160
42 / lymphorrhagia.mp. / 19
43 / abscess.mp. / 60935
44 / pneumonia/ / 34051
45 / (resect* adj4 ureter*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 648
46 / urinoma/ / 50
47 / leak*.ti,ab. / 64509
48 / wound infection/ or wound complication/ / 8765
49 / stricture*.ti,ab. / 18786
50 / (failure adj3 anastomo*).ti,ab. / 395
51 / fistula*.ti,ab. / 65647
52 / gastroparesis.ti,ab. / 1369
53 / hematoma/ or hematoma*.ti,ab. / 37316
54 / haemorrhage.ti,ab. / 24240
55 / hemorrhage.ti,ab. / 87848
56 / Lymphedema.ti,ab. / 3917
57 / lymphoedema.ti,ab. / 1434
58 / pancreatic occlusion.mp. / 5
59 / pneumothorax/ / 12003
60 / Vascular anastomo*.ti,ab. / 1529
61 / intubation/ / 4383
62 / Respiration, Artificial/ / 35426
63 / drain*.ti,ab. / 83369
64 / Pancreatitis/ / 36536
65 / Peripheral Nerve Injuries/ / 3778
66 / (bladder or bowel).mp. and injur*.ti,ab. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 10097
67 / Intestinal Perforation/ / 10185
68 / Pulmonary Embolism/ / 29224
69 / or/24-68 / 833439
70 / hepatectomy.mp. / 24025
71 / pancreaticojejunostomy/ / 727
72 / splenectomy/ / 17946
73 / spleen/ / 100257
74 / lobectomy/ / 454
75 / lymph node dissection/ / 22329
76 / endometriosis/ / 15352
77 / (excision or resection).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 252300
78 / hysterectomy/ / 21547
79 / 76 and 77 / 1114
80 / (hemi-hepatectomy or hemihepatectomy).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 559
81 / 73 and 77 / 596
82 / (Whipple or Whipple's).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 3440
83 / ((nerve sparing or nerve-sparing) and prostatectomy).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 917
84 / radical prostatectomy.mp. / 11093
85 / Pancreatectomy/ / 8548
86 / (lobe and resect*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 7238
87 / (lobectomy and lung).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 5831
88 / hemihepatectomy.ti,ab. / 514
89 / lung resection.mp. / 2505
90 / Prostatectomy/ / 19169
91 / Nephrectomy/ / 25203
92 / Lymph Node Excision/ / 22329
93 / (liver and resect*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier] / 24089
94 / 70 or 71 or 72 or 74 or 75 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88 or 89 or 90 or 91 or 92 or 93 / 168416
95 / 17 and 23 and 69 and 94 / 1648
96 / limit 95 to (humans and yr="2002 -Current" and english) / 911
97 / (addresses or autobiography or bibliography or biography or case reports or classical article or comment or dictionary or directory or editorial or festschrift or historical article or in vitro or interactive tutorial or interview or lectures or legal cases or legislation or letter or news or newspaper article or patient education handout or periodical index or portraits or practice guideline or video-audio media or webcasts).pt. / 3488932
98 / 96 not 97 / 880
99 / limit 98 to ("all infant (birth to 23 months)" or "newborn infant (birth to 1 month)" or "infant (1 to 23 months)" or "preschool child (2 to 5 years)" or "child (6 to 12 years)") / 66
100 / 98 not 99 / 814
Table A3: Details of Embase search
Searches / Results1 / Socioeconomics/ / 98811
2 / Cost benefit analysis/ / 60489
3 / Cost effectiveness analysis/ / 80602
4 / Cost of illness/ / 12985
5 / Financial management/ / 96283
6 / Health care cost/ / 109422
7 / Health economics/ / 30977
8 / Hospital cost/ / 11949
9 / cost$.tw. / 377088
10 / (length and stay).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 82026
11 / (duration and stay).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 27227
12 / (resource adj3 us*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 8620
13 / hospitali*.mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 286668
14 / "Costs and Cost Analysis"/ / 48041
15 / emergency health service/ or emergency care/ / 70593
16 / outpatient department/ / 33910
17 / (resource* adj3 utili*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 9079
18 / (resource* adj2 us*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 13388
19 / "length of stay"/ / 63631
20 / exp postoperative complication/ / 429024
21 / expPeroperative Complication/ / 16504
22 / exp perioperative complication/ / 2994
23 / complication$.mp. / 948157
24 / exp complication/ / 551710
25 / (intraoperative adj3 complication*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 9151
26 / adverse event*.mp. / 90813
27 / 20 or 21 or 22 or 23 or 24 or 25 or 26 / 1248441
28 / bleeding/ / 137456
29 / abscess/ or subphrenic abscess/ or abdominal abscess/ or pelvis abscess/ or perirenal abscess/ / 34806
30 / wound infection/ or postoperative infection/ or surgical infection/ / 63605
31 / infection/ or urogenital tract infection/ or lung infection/ or hospital infection/ or lower respiratory tract infection/ or urinary tract infection/ or abdominal infection/ or secondary infection/ or biliary tract infection/ / 243069
32 / (abdominal adj2 collection).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 170
33 / injury/ or nerve injury/ or nervous system injury/ or surgical injury/ / 243702
34 / acute pancreatitis/ / 14173
35 / anemia/ / 91840
36 / atelectasis/ / 9073
37 / bacteremia/ / 23936
38 / nerve paralysis/ / 3745
39 / bladder injury/ / 2087
40 / bladder perforation/ / 996
41 / intestine injury/ or bowel injury.mp. / 5662
42 / colon injury/ / 1474
43 / fluid collection.mp. or abdominal abscess/ / 7124
44 / empyema/ / 5891
45 / wound dehiscence/ or anastomosis dehiscence/ or dehiscence.mp. / 14244
46 / nerve injury/ / 16363
47 / (nerve adj3 injur*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 33770
48 / hemoperitoneum/ / 4231
49 / lymphocele.mp. / 1812
50 / lymphocyst.mp. / 160
51 / lymphorrhea.mp. / 238
52 / lymphorrhagia.mp. / 24
53 / abscess.mp. / 81823
54 / pneumonia/ / 84057
55 / (resect* adj4 ureter*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 810
56 / urinoma/ / 715
57 / leak*.ti,ab. / 76141
58 / wound infection/ or wound complication/ / 27351
59 / stricture*.ti,ab. / 23645
60 / (failure adj3 anastomo*).ti,ab. / 483
61 / fistula*.ti,ab. / 75851
62 / gastroparesis.ti,ab. / 2074
63 / hematoma/ or hematoma*.ti,ab. / 52269
64 / haemorrhage.ti,ab. / 29453
65 / hemorrhage.ti,ab. / 103656
66 / Lymphedema.ti,ab. / 5081
67 / lymphoedema.ti,ab. / 1834
68 / pancreatic occlusion.mp. / 6
69 / perforation/ / 5930
70 / pneumothorax/ / 19971
71 / lung embolism/ / 50825
72 / seroma/ / 3184
73 / Vascular anastomo*.ti,ab. / 1737
74 / hepatectomy.mp. / 16306
75 / pancreas resection/ / 11917
76 / pancreaticojejunostomy/ / 1408
77 / splenectomy/ / 24125
78 / spleen/ / 84939
79 / lung lobectomy/ / 4419
80 / lobectomy/ / 4894
81 / lymph node dissection/ / 15940
82 / endometriosis/ / 21188
83 / (excision or resection).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 359312
84 / hysterectomy/ / 29000
85 / hemihepatectomy/ / 659
86 / 82 and 83 / 1762
87 / (hemi-hepatectomy or hemihepatectomy).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 1037
88 / 78 and 83 / 1222
89 / lung resection/ / 22791
90 / radical retropubic prostatectomy/ / 737
91 / partial nephrectomy/ / 3949
92 / pelvis lymphadenectomy/ / 2799
93 / (Whipple or Whipple's).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 3863
94 / ((nerve sparing or nerve-sparing) and prostatectomy).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword] / 1553
95 / radical prostatectomy.mp. / 16448
96 / 74 or 75 or 76 or 77 or 79 or 80 or 81 or 84 or 85 or 86 or 87 or 88 or 89 or 90 or 91 or 92 or 93 or 94 or 95 / 151819
97 / (book or book series or editorial or letter or note or trade journal).pt. / 1792209
98 / liver resection/ / 24499
99 / 96 or 98 / 165507
100 / 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 / 1094940
101 / 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 or 72 or 73 / 1267857
102 / drain*.ti,ab. / 100384
103 / artificial ventilation/ / 70234
104 / intubation/ / 13496
105 / 101 or 102 or 103 or 104 / 1393836
106 / 27 and 99 and 100 and 105 / 4121
107 / limit 106 to (human and yr="2002 -Current") / 2808
108 / 107 not 97 / 2742
109 / limit 108 to (embryo <first trimester> or infant <to one year> or child <unspecified age> or preschool child <1 to 6 years> or school child <7 to 12 years>) / 151
110 / 108 not 109 / 2591
111 / limit 110 to english / 2398
Table A4: Details of Econlit search
Searches / Results1 / complication$.mp. / 554
2 / injury*.mp. [mp=heading words, abstract, title, country as subject] / 894
3 / anemia.mp. [mp=heading words, abstract, title, country as subject] / 37
4 / atelectasis.mp. [mp=heading words, abstract, title, country as subject] / 0
5 / bacteremia.mp. [mp=heading words, abstract, title, country as subject] / 0
6 / empyema.mp. [mp=heading words, abstract, title, country as subject] / 0
7 / dehiscence.mp. [mp=heading words, abstract, title, country as subject] / 0
8 / anastomo*.mp. [mp=heading words, abstract, title, country as subject] / 0
9 / hemoperitoneum.mp. [mp=heading words, abstract, title, country as subject] / 0
10 / lymphocele.mp. [mp=heading words, abstract, title, country as subject] / 0
11 / lymphocyst.mp. [mp=heading words, abstract, title, country as subject] / 0
12 / lymphorrhea.mp. [mp=heading words, abstract, title, country as subject] / 0
13 / lymphorrhagia.mp. [mp=heading words, abstract, title, country as subject] / 0
14 / pneumonia.mp. [mp=heading words, abstract, title, country as subject] / 48
15 / urinoma.mp. [mp=heading words, abstract, title, country as subject] / 0
16 / leak*.mp. [mp=heading words, abstract, title, country as subject] / 700
17 / wound.mp. [mp=heading words, abstract, title, country as subject] / 25
18 / stricture*.mp. [mp=heading words, abstract, title, country as subject] / 55
19 / failure.mp. [mp=heading words, abstract, title, country as subject] / 9995
20 / fistula*.mp. [mp=heading words, abstract, title, country as subject] / 3
21 / gastroparesis.mp. [mp=heading words, abstract, title, country as subject] / 0
22 / hematoma.mp. [mp=heading words, abstract, title, country as subject] / 1
23 / haemorrhage.mp. [mp=heading words, abstract, title, country as subject] / 4
24 / hemorrhage.mp. [mp=heading words, abstract, title, country as subject] / 8
25 / Lymphedema.mp. [mp=heading words, abstract, title, country as subject] / 0
26 / lymphoedema.mp. [mp=heading words, abstract, title, country as subject] / 0
27 / occlusion.mp. [mp=heading words, abstract, title, country as subject] / 2
28 / pneumothorax.mp. [mp=heading words, abstract, title, country as subject] / 1
29 / intubation.mp. [mp=heading words, abstract, title, country as subject] / 0
30 / ventilation.mp. [mp=heading words, abstract, title, country as subject] / 28
31 / drain*.mp. [mp=heading words, abstract, title, country as subject] / 974
32 / Pancreatitis.mp. [mp=heading words, abstract, title, country as subject] / 0
33 / Perforation.mp. [mp=heading words, abstract, title, country as subject] / 1
34 / Pulmonary Embolism.mp. [mp=heading words, abstract, title, country as subject] / 6
35 / adverse.mp. [mp=heading words, abstract, title, country as subject] / 6704
36 / 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 / 19727
37 / surger*.mp. / 304
38 / surgical.mp. / 212
39 / procedure*.mp. / 19956
40 / operat*.mp. / 35783
41 / resect*.mp. / 4
42 / laparotom*.mp. / 0
43 / laparoscop*.mp. / 4
44 / robot.mp. / 76
45 / 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 / 54615
46 / 36 and 45 / 1506
47 / limit 46 to (yr="2002 -Current" and english) / 944
48 / limit 47 to (books or book reviews) / 26
49 / 47 not 48 / 918
1
Table A5: Costs associated with HPB surgery
Study / Comparison group / n / Currency/cost year¶ / Preoperative / Intraoperative / Postoperative / Indirect costs / Total hospital costs [2013 US$]Pancreaticoduodenectomy
Daskalaki, 2011 / No POPF / 408 / EUR‡/NR (1996) / tests and radiological investigations: 179.6 / Operating theatre: 3,567.58 / Hospital stay:
3600
radiological imaging:
80
Laboratory:
472.8 / 1994.48 / 9665.56 [17886.09]
Grade A POPF / 28 / tests and radiological investigations: 179.6 / Operating theatre: 3,567.58 / Hospital stay:
4,950
radiological imaging:
80
Laboratory:
472.8 / 2404.99 / 11654.97 [21567.48]
Grade B POPF / 104 / tests and radiological investigations: 179.6 / Operating theatre: 3,567.58 / Hospital stay:
10,800
Transfusions:
70
Total parenteral or enteral nutrition:
1,540
Octreotide:
241.65
radiological imaging:
897
Laboratory:
1,141.25 / 5302.81 / 25698.24 [47554.52]
Grade C POPF / 13 / tests and radiological investigations: 179.6 / Operating theatre: 3,567.58 / Hospital stay:
20,700
Intensive care:
6500
Reoperation:
2000
Transfusions:
280
Total parenteral or enteral nutrition:
3,700
Octreotide:
483.3
radiological imaging:
1,674
Laboratory:
1,815.20 / 12,276.25 / 59492.64 [110090.96]
Fuks, 2009 / - / - / - / - / - / - / - / -
Haddad, 2009 / - / - / - / - / - / - / - / -
Topal, 2007 / All patients / 109 / EUR †/NR (2005) / - / - / - / - / 10406 (5570 - 30999)
[16325 (8738-48634)]
Patients with post operative pancreatic fistula (POPF) / 14 / - / Operation room: 2264 (1007-6475) / Hospital stay: 4847 (520-7956)
Intensive care: 0 (0-3667)
Emergency: 0(0-87)
Functional measurement: 0 (0-227)
Imaging: 142 (0-512)
Laboratory: 1164 (707-9712)
Medical Staff (unspecified): 2057 (1296-5132)
Paramedical personnel: 259 (0-1035)
Pharmacy: 3140 (2008-7298)
Care logistics: 53 (53-159) / - / 15225 (10171-30685) [23886 (15957-48141)]
Patients with complications other than POPF / 37 / - / Operation room: 2199 (1002-5079) / Hospital stay: 3639 (1213-13493)
Intensive care: 0 (0-7215)
Emergency: 0 (0-499)
Functional measurement: 33 (0-821)
Imaging: 109 (0-685)
Laboratory: 877 (412-5147)
Medical Staff (unspecified): 1950 (1301-5750)
Paramedical personnel: 194 (0-1805)
Pharmacy: 1526 (500-5871)
Care logistics:
0 (0-499) / - / 11393 (6716- 30999) [17874 (10536-48634)]
Patients without complications / 58 / - / Operation room: 2131 (970-6425) / Hospital stay: 2686 (1213-7358)
Intensive care: 0 (0-1467)
Emergency: 0 (0-673)
Functional measurement: 0 (0-227)
Imaging: 53 (0-289)
Laboratory: 640 (277-2206)
Medical Staff (unspecified): 1735 (1158-3060)
Paramedical personnel:
0 (0-776)
Pharmacy: 978 (460-4340)
Care logistics: 0 (0-673) / - / 8565 (5569-16921) [13437 (8737-26547)]
Patients with grade 1 TOSGS-score of complication / 2 / - / - / - / - / 7696 (7013-8378) [12074 (11002-13144)]
Patients with grade 4 TOSGS-score of complication / NR / - / - / - / - / NR
Patients with grade 5 TOSGS-score of complication / 2 / - / - / - / - / 19355 (8026-30685) [30366 (12591-48141)]
Vanounou, 2007§ / All patients / NR / US $/NR (2007) / - / - / - / - / NR
No pancreatic fistula or other complication / 167 / - / - / - / - / 18,254 [21,357]
Any grade of fistula / NR / - / - / - / - / NR
Grade A pancreatic fistula / 26 / - / - / - / - / 18,235 [21,334]
Grade B pancreatic fistula / 28 / - / - / - / - / 30,581 [35,779]
Grade C pancreatic fistula / 6 / - / - / - / - / 113,084 [132,308]
Pancreatic resection
Casadei, 2011 / - / - / - / - / - / - / - / -
Glowka, 2010 / - / - / - / - / - / - / - / -
Jimenez, 2007 / - / - / - / - / - / - / - / -
Rodriguez, 2006 / Pancreatic stump leak (PL) related complications / 22 / US $/NR (2004) / - / - / - / - / The average patient with PL-related problem incurred a total cost that was 2.01 times greater than the average patient in the no-PL group. This yielded a cost differential of $14,179 [17,581], which was largely accounted for by hospital-related costs. A decision analytic model developed to evaluate threshold costs showed thata hypothetical intervention designed to reduce the complication rate of distal pancreatectomy by one third would be financially justifiable up to a cost of $1418 [1758] per patient. Alternatively, an intervention that reduced PLs to 0% could cost up to $4254 [5274] and still be economically justified. Many of the PLs were manifesting as both a fistula and a sterile collection, or a fistula and an abscess.
Simons, 2009 / - / - / - / - / - / - / - / -
Pancreaticoduodenectomy and Pancreatectomy (Mixed populations)
Behrman, 2008 / - / - / - / - / - / - / - / -
Belyaev, 2011 / - / - / - / - / - / - / - / -
Kent, 2011§ / All patients / 578 / US $/NR (2009) / - / - / - / - / Initial admission: NR
No readmission within 30 days (all resection types) / 467 / - / - / - / - / Initial admission (total cost): 24,679 [26,900]
30-Day readmitted patients (all resection types) / 111 / - / - / - / - / Initial admission: 30,988 [33,776]
Readmission: 10,159 [11,073]
Overall Hospital costs (initial surgery + readmissions): 40,583 [44,235]
Pratt, 2009 / All patients / 405 / US $/NR (2008) / - / - / - / - / NR
‘No relevance’ (patients who either lacked evidence of fistula or demonstrated biochemical evidence alone) / 349 / - / - / - / - / Total, including readmission cost:
17556 (IQR 15176–22071) [19312 (IQR 16694-24278)]
Evident fistula / 36 / - / - / - / - / Total, including readmission cost:
23542 (IQR 17337–43640) [25896 (IQR 19071-48004)]
Latent Fistula / 20 / - / - / - / - / Total, including readmission cost:
31750 (IQR 20907–47743) [34925 (IQR 22998-52517)]
Type I: subacutelatent pancreatic fistula / 6 / - / - / - / - / Total, including readmission cost:
22873 (IQR 17508–30248) [25160 (IQR 19259-33273)]
Type II: acute latent pancreatic fistula / 8 / - / - / - / - / Total, including readmission cost:
32206 (IQR 19312–102146) [35427 (IQR 21243-112361)]
Type III: critical latent pancreatic fistula / 6 / - / - / - / - / Total, including readmission cost:
40517 (IQR 34864–107454) [44569 (IQR 38350-118199)]
Hepatic resection
Breitenstein, 2010 / All patients / 615 / US $/NR (2009) / - / - / - / - / 35,028 (IQR 25,572-51,338) †, 51,497 (59,418) ‡[38531 (IQR 28129-56472) 56647 (65360)]
no complications, or Grade I or II complications / 456 / - / - / - / - / 31,669 (IQR 24,019-40,795) †, 36,931 (27,854) ‡[34836 (IQR 26421-44875) 40624 (30639)]
grade III or IV complications / 159 / - / - / - / - / 65,228 (IQR 43,130-98,811) †, 94,545 (96,252) ‡[71751 (IQR 47443-108692) 104000 (105877)]
Score 0-2 (low-risk of postoperative complications) / NR / - / - / - / - / 32,371 (IQR 24,174-42,830) †, 43,247 (46,991) ‡[35608 (IQR 26591-47113) 47572 (51690)]
Score 3-5 (intermediate risk of postoperative complications) / NR / - / - / - / - / 35,194 (IQR 26,426-53,597) †, 51,940 (51,295) ‡[38713 (IQR 29069-58957) 57134 (56425)]
Score 6-10 (high risk of postoperative complications) / NR / - / - / - / - / 62,210 (IQR 41,245-89,362) †, 86,863 (99,215) ‡[68431 (IQR 45370-98298) 95549 (109137)]
Abbreviations: NR, not reported
†Median (range), or Median (interquartile range) values reported ‡Mean (sd) or mean (range) reported §Further data is extracted in the accompanying DET file¶ Where the cost year is not reported, the year of data collection (or end thereof for ranges) was used (provided in brackets)
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Table A6: Resource use associated with HPB surgery
Study / Comparison group / n / Hospital stay (days) / ICU days/visits / Re-operation / Blood transfusion / Medication use / Tests/Diagnosis / OtherPancreaticoduodenectomy
Daskalaki, 2011 / No POPF / 408 / 8 / - / - / - / - / - / -
Grade A POPF / 28 / 11 / - / - / - / - / - / -
Grade B POPF / 104 / 24 / - / - / - / - / - / -
Grade C POPF / 13 / 46 / - / - / - / - / - / -
All patients with POPF / 147 / 19 (IQR 14-27.5) / - / 17 (11.6%)
Time to reoperation:
12 days (IQR 12–16.5) from the PD
percutaneous drainage US-CT guided for intra-abdominal collections: 5 (3.4%)
endoscopic procedure due to hematemesis: 1 (0.7%) / - / - / - / -
Fuks, 2009 / All patients / 680 / NR
All pancreatic fistula patients / 111 / NR; mean duration of drainage output was 13 (11) days (range 4–45). / - / - / 9 (11%) / - / - / -
Grade A/B pancreatic fistula / 75 / 29 (9) / - / required percutaneous drainage for intra-abdominal collection : 7 / 21 (30.8%) / all Grade B patients treated with total parenteral nutrition: 32
somatostatin analogues: 75% / - / -
Grade C pancreatic fistula / 36 / 46 (16) / - / reoperation in 35 (97%):
for intra-abdominal collections: 7
emergency surgery for hemodynamic instability: 2
reoperation with isolated elective haemostasis for bleeding: 14
surgical pancreatic drainage: 17
percutaneous drainage: 7 / 16 (51.6%) / somatostatin analogues: 73% / Angiography with embolization: 2 / -
Haddad, 2009 / All patients / 117 / NR / - / NR / Intra-operative, Red blood cells units: 0.7 (0–12) / - / - / -