The global cost of pelvic exenteration: in-hospital perioperative costs

This is the authors' abstract. We don't add key points for this paper.

Editor Pelvic exenteration for advanced pelvic malignancies is increasingly being performed in specialist units with good survival outcomes1. Multivisceral surgery is challenging and associated with considerable morbidity. Ultimately, management strategies involve multiple treatment modalities and input from the multidisciplinary team2. Radical surgery to ensure clear margins is complex, and operative times are long (Mean +/−SD= 509+/−201minutes)3. Reconstruction and rehabilitation following surgery is both time and resource-consuming and post-operative recovery can be long4. To date there is little actual costs on the care of these patients. Global healthcare expenditure has significantly increased over the last few decades, with approximately one-third of costs relating to surgery5. The PelvEx Collaborative, provides outcome data on patients with advanced pelvic neoplasms requiring exenteration. Involved institutions audited their inpatient financial costs for providing exenterative care. Specifically, we assessed the availability of an established price bundle for the perioperative care of an exenteration. Specific radiological imaging and operative/post-operative healthcare costs including the price of one hour in the operating room, and one day in a hospital bed/intensive care unit were assessed. Individual costs were converted to US dollars (USD) based on purchasing pay parity rates, that try to equalise purchasing power of different currencies6. Interquartile range (H-spread) with upper and lower quartiles are given. To compare similar countries, we categorized countries according to the sustainable development goal index (SDG index), which integrates several important components that make-up the evolution of each nation's development7.

May guide institutional budgeting for pelvic exenteration; leaves open comparative cost-effectiveness across systems.