Clinical science
Complications nearly double the cost of care after pancreaticoduodenectomy

Presented at the International Hepato-Pancreato-Biliary Association 9th World Congress, Buenos Aires, Argentina, April 18–22, 2010.
https://doi.org/10.1016/j.amjsurg.2011.10.019Get rights and content

Abstract

Background

Despite considerable data focused on the morbidity of pancreaticoduodenectomy (PD), the financial impact of complications has been infrequently analyzed. This study evaluates the impact of the most common complications associated with PD on the cost of care. Additionally, we identified cost centers that were significantly affected by complications.

Methods

A retrospective analysis of a prospective database in a network of community-based teaching hospitals was performed. All patients (n = 145) who underwent PD were included for years 2005 to 2009. Of these, 144 had complete in-hospital cost data. Complications were assessed and classified into major and minor categories according to Dindo et al. Forty-nine cost centers were analyzed for their association with the cost of complications. Univariate and multivariate linear regression analyses were performed. Significance was reported for P < .05.

Results

The median cost for PD was $30,937. Patients with major complications had significantly higher median cost compared with those without ($56,224 vs $29,038; P < .001). Independent predictors of increased cost included reoperation; sepsis; pancreatic fistula; bile leak; delayed gastric emptying; and pulmonary, renal, and thromboembolic complications. Cost center analysis showed significant added charges for patients with major complications for blood bank ($1,018), clinical laboratory ($3,731), a computed tomography scan ($4,742), diagnostic imaging ($697), intensive care unit ($4,986), pharmacy ($33,850) and respiratory therapy ($1,090) (P < .05, all).

Conclusions

This study identified the major complications of PD, which are significantly associated with a higher cost. Substantial cost center increases were associated with major complications, particularly in pharmacy ($33,850). Measures aimed at limiting complications through centralization of care or care pathways may reduce the overall cost of care for patients after pancreatic resection.

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

References (32)

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