BACKGROUND

The Division of Colorectal Surgery at the Philippine General Hospital (PGH) conducts hundreds of surgeries annually for benign and malignant colorectal conditions. Since 2019, the Division has implemented an Enhanced Recovery After Surgery (ERAS) program to improve patient outcomes. However, its impact on hospital costs—critical for a government hospital—has not yet been studied.

OBJECTIVE

This study aimed to evaluate the effect of ERAS on healthcare costs for elective colorectal surgeries performed at PGH in 2021.

METHODS

A retrospective observational study was conducted on adult patients who underwent elective colorectal surgeries under the ERAS protocol in 2021. Medical and billing records were retrieved using the hospital’s electronic medical records (EMR) system, excluding cases with incomplete data. Procedures were categorized by type [stoma closure, colonic or rectal resection, reversal of Hartmann’s, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)] and surgical approach (open, laparoscopic, or robotic). Costs were classified into diagnostics, facility fees, medications, surgery, and hospital supplies. ERAS compliance rates were extracted from the online ERAS Interactive Audit System (EIAS), and linear regression analysis was performed.

RESULTS

Among 114 elective colorectal surgeries, records for 90 cases were analyzed. Surgery-related expenses accounted for the highest mean hospital costs across all procedure types. An inverse correlation between ERAS compliance and total cost was observed for open surgeries, with statistically significant reductions in stoma closures and open colon resections (p-value: 0.0213 and 0.0134, respectively). However, minimally invasive surgeries (MIS) did not demonstrate cost reductions with increasing ERAS compliance, likely due to additional expenses associated with advanced equipment. Linear regression indicated that higher compliance rates generally led to decreased hospital costs.

CONCLUSION

Standardized care through ERAS has been associated with cost savings compared to traditional perioperative management. This study supports the conclusion that higher ERAS compliance can reduce hospital costs in open colorectal surgeries. However, the higher costs of MIS procedures, driven by equipmentrelated expenses, may offset potential savings from ERAS adherence. Further research is warranted to explore the cost implications of ERAS in MIS cases.

Costs And Cost Analysis ; Colorectal Surgery

OBJECTIVE

To present a case of Langerhans cell histiocytosis mimicking bilateral otitis media and acute mastoiditis in a one-year-old girl, and to discuss the clinical presentation, diagnostic dilemma, management and prognosis of this disease.

METHODS

Design: Case Report

Setting: Tertiary Private Teaching Hospital

Patient: One

RESULTS

A one-year-old girl with a three-month history of bilateral otorrhea, post-auricular lymphadenopathies and dermatitits unresponsive to multiple courses of antibiotics, developed osseous and soft tissue destruction around the temporal and occipital bones. Her multiple progressive symptoms eventually led to the diagnosis of Langerhans cell histiocytosis.

CONCLUSION

Langerhans cell histiocytosis is a multifocal disease that can present with ear symptoms and can cause management dilemmas. It may mimic acute or chronic infections of the ear and should be suspected when extensive bone erosion is present.

Human ; Female ; Infant: 1-23 Months ; Histiocytosis, Langerhans-cell ; Otitis ; Mastoiditis

OBJECTIVE: To report a case of a 12-year-old boy with Necrotizing Lymphadenitis (Kikuchi-Fujimoto disease) presenting as lymphadenitis secondary to multiple diagnosis.

 

METHODS:

Design : Case Report

Setting: Tertiary Private Hospital

Patient: One

 

RESULTS: A 12-year-old boy consulted for two-month history of cervical lymphadenopathy with the underlying cause remaining unclear despite multiple consults, diagnosis and medical treatment. Lymphoma was considered and excision biopsy with further investigations confirmed a diagnosis of Kikuchi-Fujimoto disease. Supportive management was given with no recurrence of symptoms noted on 18 months of follow up. 

 

CONCLUSION:  Kikuchi-Fujimoto disease in this case was a diagnosis of exclusion. Even with a proper history and physical examination, experts in otolaryngology can be misled to manage this case as malignant. Awareness of the disease and appropriate examinations including immunohistochemistry are important for a timely diagnosis and proper intervention.

 

KEYWORDS: lympadenitis; Kikuchi-Fujimoto disease; lymphoma; cervical lymph nodes

Human ; Male ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Histiocytic Necrotizing Lymphadenitis ; Lymphoma

OBJECTIVES: To determine the prevalence and identify the types of Nasopharyngeal Carcinoma (NPCA) among patients with nasopharyngeal mass seen at a tertiary university training hospital in  the  Philippines  from  January  2006  -  July  2012  and  identify  possible  factors associated  with nasopharyngeal carcinoma.
METHODS: A  retrospective  cross-sectional  study  was  performed  at  a  tertiary  university  training hospital among cases (n=179) seen with nasopharyngeal mass at the ENT outpatient department. Histopathology results and patient medical charts were collected and reviewed after IRB approval. The  age  at  diagnosis,  sex,  place  of  residence,  occupation  and  chief  complaint  was  compared among patients with positive histopathology of NPCA only.
 Design: Retrospective, cross sectional study
 Setting: Tertiary Private University Training Hospital
 Participants: One hundred seventy nine (179) patients with nasopharyngeal mass
RESULTS: Ninety six (54%) cases with nasopharyngeal mass seen at the ENT outpatient department were positive for nasopharyngeal malignancy. The remaining 83 (46%) cases with nasopharyngeal mass had a benign histopathology. NPCA was more common among males (58%) than females (42%).  The  most  common  form  of  NPCA  was  non-keratinizing  undifferentiated  NPCA  (47%) followed by poorly differentiated squamous cell carcinoma in 18 (19%). The most common chief complaint was a neck mass, followed by decreased hearing.
CONCLUSION: There  was  a  higher  proportion  of  nasopharyngeal  malignancy  among  male patients  with  nasopharyngeal  mass,  and  the  most  common  chief  complaint  was  a  neck  mass. Future  research  should  integrate  data  with  other  hospital  institutions  to  obtain  more  accurate demographic  data  of  the  local  prevalence  of  NPCA.  A  detailed  record  of  the  ethnicity,  diet, occupation, smoking history and family history of cases should be obtained to correlate possible risk factors of NPCA among patients with nasopharyngeal mass in our setting.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Carcinoma ; Epidemiology ; Prevalence