Background : There is an Increasing burden on healthcare facilities with the growing world population especially in a resource limited setting. Day Of Surgery Admission (DOSA) has proven to be a Cost-effective strategy in healthcare with resource limitations. Our aim was to evaluate the cost effectiveness of a DOSA approach in elective Hepato-Pancreatico-Biliary (HPB) surgery in a resource limited setting where patients face multiple barriers to accessing quality health care.

Methods : This study was conducted at Shaukat Khanum Memorial Cancer Hospital &Research Center (SKMCH&RC) after getting Institutional Review Board approval for the study. It was a retrospective study including all elective HPB cases between 30 June 2019 – 30 June 2022 admitted via the DOSA approach. The cost per night stay was calculated with the help of the hospital’s business office. SPSS 20 was used for statistical analysis

Results : A total of 71 patients underwent Elective HPB surgery via the DOSA approach that included 38 Cholecystectomies, 10 Liver Resections, and 23 Pancreatic Resections. There was no delay in start of surgery or any cancellations due to outstanding investigations. Patients reported satisfaction and reduction in anxiety and there was a reduction in overall length of stay compared to patients who did not undergo DOSA approach. There was no difference in complications associated with surgery between both groups. This approach resulted in a cost reduction of 11,096 PKR for pancreatic resection, 12,652 PKR for liver resection, and 10,470 PKR for cholecystectomy. Total savings done via the DOSA approach in our HPB center were 779,588 PKR.

Conclusions : DOSA is an effective cost-reduction strategy for major elective surgeries in our HPB unit. Being in a resource poor health care setting is not a barrier to implementation of this strategy and may result in cost effective provision of health care.