Assessment of health care cost for complex surgical patients: review of cost, re‐imbursement and revenue involved in pancreatic surgery at a high‐volume academic medical centre. Issue 4 (9th October 2014)

• Record Type: Journal Article
• Authors: Kachare, Swapnil D.; Liner, Kendall R.; Vohra, Nasreen A.; Zervos, Emmanuel E.; Hickey, Todd; Fitzgerald, Timothy L.
• Is Part Of: HPB. Volume 17:Issue 4(2015:Apr.)
• Page Start: 311
• Page End: 317
• Publication Date: 2014-10-09
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12349
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12349-sec-0001" sec-type="section"> <title>Background</title> <p>Pancreatic surgery is complex with the potential for costly hospitalization.</p> </sec> <sec id="hpb12349-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective review of patients undergoing a pancreatic resection was performed.</p> </sec> <sec id="hpb12349-sec-0003" sec-type="section"> <title>Results</title> <p>The median age of the study population was 64 years. Half of the cohort was female (51%), and the majority were white (62%). Most patients underwent a pancreaticoduodenectomy (PD) (69%). The pre‐operative age‐adjusted Charlson comorbidity index was zero for 36% (<italic>n</italic> = 50), 1 for 31% (<italic>n</italic> = 43) and ≥2 for 33% (<italic>n</italic> = 45). The Clavien–Dindo grading system for post‐operative complication was grade I in 17% (<italic>n</italic> = 24), whereas 45% (<italic>n</italic> = 62) were higher grades. The medians direct fixed, direct variable, fixed indirect and total costs were $2476, $15 397, $13 207 and $31 631, respectively. There was a positive contribution margin of $7108, whereas the net margin was a loss of $6790. On univariate analyses, age, type of operation and complication grade were associated with total cost (<italic>P</italic> ≤ 0.05), whereas operation type and complication grade were associated with a net margin (<italic>P</italic> = 0.01). These findings remained significant on multivariate analysis (<italic>P</italic> < 0.05).</p> </sec> <sec id="hpb12349-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Increased cost, reimbursement and revenue were associated with type of operation and post‐operative complications.</p> </sec> </abstract>