High-Volume Anesthesiologist and Surgeon Teams are Associated with Lower Operating Room Charges for Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.

INTRODUCTION

Anesthesiologist and surgeon experience are associated with improved outcomes and lower costs in various oncologic procedures. The role of the anesthesiologist-surgeon dyad on outcomes and charges for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has not been studied.

METHODS

We performed a retrospective cohort study of patients undergoing CRS-HIPEC at a single quaternary center from 2016 to 2023. High-volume anesthesiologists (ANES) and surgeons (SURG) were defined as those in the top quartile of cases for their respective position (ANES: 10 cases, SURG: 87 cases). The study cohort was then divided into four subcohorts based on anesthesiologist and surgeon volume: low-volume anesthesiologist and surgeon (LALS), high-volume anesthesiologist and low-volume surgeon (HALS), low-volume anesthesiologist and high-volume surgeon (LAHS), and high-volume anesthesiologist and surgeon (HAHS).

RESULTS

The study cohort consisted of 237 patients undergoing CRS-HIPEC from 2016 to 2023. Median age was 59 years (interquartile range 48-66). Most patients were female (n = 135, 57%), White (n = 174, 73%), and privately insured (n = 134, 57%). The HAHS cohort had the lowest median total ($99,921, p = 0.603), operating room ($33,560, p = 0.266), and other ($11,384, p = 0.437) charges compared with the other cohorts. After adjusting for patient complexity, the HAHS cohort had significantly lower operating room charges (estimate -$5784, 95% confidence interval [-$11,076 to -$491], p = 0.032), length of stay (- 4.77 days, [- 9.04 to - 0.51 days], p = 0.029), and odds of delayed extubation (odds ratio 0.79, 95% confidence interval [0.65-0.98], p = 0.029) compared with the LALS cohort.

CONCLUSIONS

The HAHS teams are associated with significantly lower operating room charges, length of stay, and delayed extubation compared with LALS teams in CRS-HIPEC.