Clinical and Economic Implications of Interventions in Pancreatic Fluid Collections

Abstract

Objective To compare clinical and economic implications of percutaneous and endoscopic treatment approaches in patients with pancreatic fluid collections (PFCs). Materials and Methods This is a retrospective claims analysis of Medicare beneficiaries who underwent inpatient endoscopic or percutaneous PFC drainage procedures (2016–2020). We performed longitudinal analysis of claims for all-cause mortality and rehospitalization during 180-day follow-up. Main outcome was mortality. Other outcomes were rehospitalization and direct costs. Results A total of 1311 patients underwent endoscopic (n = 727) or percutaneous (n = 584) drainage. Percutaneous as compared with endoscopic approach was associated with higher mortality (23.08% vs 16.7%, P = 0.004), rehospitalization (58.9% vs 53.3%, P = 0.04), and mean direct hospital costs ($37,107 [SD = $67,833] vs $27,800 [SD = $43,854], P = 0.004). On multivariable analysis, percutaneous drainage (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.02–1.86; P = 0.039), older age (hazard ratio [HR], 1.04; 95% CI, 1.01–1.04; P < 0.001), intensive care unit stay (HR, 1.02; 95% CI, 1.01–1.03; P < 0.001), and multiple comorbidities (HR, 1.07; 95% CI, 1.05–1.09; P < 0.001) were significantly associated with mortality. Percutaneous drainage (adjusted odds ratio [OR], 1.30; 95% CI, 1.04–1.63; P = 0.027) and older age (OR, 0.98; 95% CI, 0.97–0.99; P < 0.001) were significantly associated with rehospitalizations. Conclusions As percutaneous drainage may be associated with higher mortality, rehospitalization, and costs, when requisite expertise is available, endoscopy should be preferred for treatment of PFC amenable to such an approach. Randomized trials are required to validate these findings.