Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital

Thomas Worland; Oliver Cronin; Benjamin Harrison; Linda Alexander; Nik Ding; Alvin Ting; Stephanie Dimopoulos; Racheal Sykes; Sina Alexander

doi:10.1055/a-0970-8828

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1386-E1392
DOI: 10.1055/a-0970-8828

Original article

Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital

Thomas Worland

¹Monash Health, Melbourne, Australia

,

Oliver Cronin

²University Hospital Geelong, Geelong, Australia

,

Benjamin Harrison

²University Hospital Geelong, Geelong, Australia

,

Linda Alexander

³The University of Notre Dame, Fremantle, Australia

,

Nik Ding

⁴St Vincent’s Hospital, Melbourne, Australia

⁵University of Melbourne, Melbourne, Australia

,

Alvin Ting

²University Hospital Geelong, Geelong, Australia

⁶Deakin University, Geelong, Australia

,

Stephanie Dimopoulos

⁶Deakin University, Geelong, Australia

,

Racheal Sykes

⁶Deakin University, Geelong, Australia

,

Sina Alexander

²University Hospital Geelong, Geelong, Australia

⁶Deakin University, Geelong, Australia

› Institutsangaben

Abstract

Background and study aims Endoscopic mucosal resection (EMR) of large sessile or laterally spreading colonic lesions is a safe alternative to surgery. We assessed reductions in Surgical Resection (SR) rates and associated clinical and financial benefits following the introduction of an EMR service to a large regional center.

Patients and methods Ongoing prospective intention-to-treat analysis of EMR was undertaken from time of service inception in 2009 to 2017. Retrospective data for SR of large sessile/laterally spreading colonic lesions were collected for the period 4 years before commencement of the EMR service (2005 – 2008) and 9 years after its introduction (2009 – 2017).

Results From 2005 to 2008, 32 surgical procedures were performed for non-malignant colonic neoplasia (50 % male, median age 68 years, median Length of Stay (LoS) 10 days). Following the introduction of the EMR service, there was a 56 % reduction in the number of patients referred for surgery (32 surgical procedures, 47 % male, median age 70 years, median LoS 8.5 days). During this period, EMR was successfully performed in 183 patients with 216 lesions resected (60 % male, median age 68 years, median LoS 1 day). Compared to the SR group, the EMR cohort had a lower peri-procedural complication rate (7.7 % vs 54.7 %, P < 0.0001), and shorter average LoS (1 vs 9 days, P < 0.0001). A cost saving of AUD $ 19 543.5 was seen per lesion removed with EMR compared to SR.

Conclusions The introduction of a dedicated EMR service into a large regional center as an alternative to SR can lead to a substantial decrease in unnecessary surgery with subsequent clinical and financial benefits.

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Referenzen

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