Cost Analysis of Externalized Pancreatic Stent Intervention to Mitigate Postoperative Pancreatic Fistula after Pancreatoduodenectomy: Experience of a High-Volume Latin American Center

Abstract

Introduction: Postoperative pancreatic fistulas (POPF) are a frequent and severe complication of pancreatoduodenectomy. The impact of external pancreatic stent (ES) on the clinical course or cost of POPF is not well understood. We reviewed our experience of pancreatoduodenectomy in a high-volume center in Latin America. Methods: Pancreatoduodenectomies performed between 2006 and 2019 were retrospectively collected regarding demographics, operative variables, and outcomes with a six-month follow-up. POPF were graded according to ISGPS 2016. Standard prices for procedures, length of stay, and imaging only associated with fistulas were considered. Chi-square test and Kruskal-Wallis ANOVA tests were performed to demonstrate differences between ES, internal stents (IS), and no-stent (NS) patient subgroups. Results: A total of 237 pancreatoduodenectomies were performed in the study period. Subgroups were found to be 57.4%, 32.5%, and 10.1% for NS, ES, and IS, respectively. Patients in the ES subgroup had a higher POPF risk score (p < 0.001). Seventy-nine patients developed POPF, of which most were graded B. Although no difference was found in overall POPF incidence, ES was associated with less POPF grade C (p = 0.007). Cost analysis showed patients with an ES had a median cost that was less than other intervention subgroups (p = 0.5). Conclusion: Our results suggest that externalized stents are an inexpensive intervention that might reduce severity and cost associated with POPF, even in patients with higher risk for POPF. Broader cost-assessment calculation should be performed.