Clinical scienceComplications nearly double the cost of care after pancreaticoduodenectomy
Section snippets
Methods
A prospectively collected database maintained at 3 community-based teaching institutions was analyzed retrospectively. The dataset included full cost accounting data. The cost data were further subdivided into specific cost centers; these data were available as charges. In all, 49 cost centers were analyzed for their association with the cost of complications. Costs analyzed included only direct costs. Indirect and fixed costs such as lost wages, staff salaries, and facilities costs were not
Results
Over the years 2005 through 2009, 145 patients met the inclusion criteria. Of these, 144 had complete in-hospital cost data and were included in the analysis. There were 12 surgeons in the study group with most cases performed by the high-volume group. The low-volume group performed 26.4% (n = 38), the intermediate group performed 16.7% (n = 24), and the high-volume group performed 56.9% (n = 82) of the PD resections.
The mean age was 64 years. There was an equal distribution between male (n =
Comments
We have shown a significant relationship between cost and major complications related to pancreaticoduodenectomy. Generally, overall costs were low in this cohort. In those patients who experience 1 or more major complications, the added costs were substantial (ie, $27,186). Major complications occurred in clusters, further contributing to the added costs for this cohort. The observed clustering of complications is likely secondary to the physiology of complications themselves, such as a
Conclusions
Complications have a substantial impact on the cost of care for patients after pancreaticoduodenectomy. In this study, there was no clear relationship between volume and cost. Surgeons treating these complex patients should focus their efforts on quality improvement with the expectation that cost containment will follow. Future efforts should include the development of clinical pathways for treating specific complications in a more cost-effective manor because the care of complications is
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