Afif N Kulaylat1, Jane R Schubart1, Eric W Schaefer2, Christopher S Hollenbeak1, Amanda B Cooper3, Niraj J Gusani4. 1. Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. 2. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. 3. Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. 4. Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. Electronic address: ngusani@psu.edu.
Abstract
BACKGROUND: Surgical costs are influenced by perioperative care, readmissions, and further therapies. We aimed to characterize costs in hepato-pancreato-biliary surgery in the United States. METHODS: The MarketScan database (2008-2010) was used to identify privately insured patients undergoing pancreatectomy (n = 2254) or hepatectomy (n = 1702). Costs associated with the index surgery, readmissions, and total short-term costs were assessed from a third party payer perspective using generalized linear regression models. RESULTS: Mean total costs of pancreatectomy and hepatectomy were $107,600 (95% confidence interval [CI], 101,200-114,000) and $81,300 (95% CI, 77,600-85,000), respectively, with corresponding surgical costs of 69.2% and 60.9%. Ninety-day readmission costs were $36,200 (95% CI, 32,000-40,400) and $34,100 (95% CI, 28,100-40,100), respectively. In multivariate analysis, readmissions were associated with an almost two-fold increase in total costs in both pancreatectomy (cost ratio = 1.98; P < 0.001) and hepatectomy (cost ratio = 1.92; P < 0.001). CONCLUSIONS: Hepato-pancreato-biliary surgery is associated with significant economic burden in the privately insured population. Substantial costs are incurred beyond the index surgical admission, with readmissions representing a major source of potentially preventable health care spending. Sustained efforts in defining high-risk populations and decreasing the burden of postoperative complications through a combination of prevention and improved outpatient management offer promising strategies to reduce readmissions and control costs.
BACKGROUND: Surgical costs are influenced by perioperative care, readmissions, and further therapies. We aimed to characterize costs in hepato-pancreato-biliary surgery in the United States. METHODS: The MarketScan database (2008-2010) was used to identify privately insured patients undergoing pancreatectomy (n = 2254) or hepatectomy (n = 1702). Costs associated with the index surgery, readmissions, and total short-term costs were assessed from a third party payer perspective using generalized linear regression models. RESULTS: Mean total costs of pancreatectomy and hepatectomy were $107,600 (95% confidence interval [CI], 101,200-114,000) and $81,300 (95% CI, 77,600-85,000), respectively, with corresponding surgical costs of 69.2% and 60.9%. Ninety-day readmission costs were $36,200 (95% CI, 32,000-40,400) and $34,100 (95% CI, 28,100-40,100), respectively. In multivariate analysis, readmissions were associated with an almost two-fold increase in total costs in both pancreatectomy (cost ratio = 1.98; P < 0.001) and hepatectomy (cost ratio = 1.92; P < 0.001). CONCLUSIONS: Hepato-pancreato-biliary surgery is associated with significant economic burden in the privately insured population. Substantial costs are incurred beyond the index surgical admission, with readmissions representing a major source of potentially preventable health care spending. Sustained efforts in defining high-risk populations and decreasing the burden of postoperative complications through a combination of prevention and improved outpatient management offer promising strategies to reduce readmissions and control costs.
Authors: Afif N Kulaylat; Audrey S Kulaylat; Eric W Schaefer; Katelin Mirkin; Andrew Tinsley; Emmanuelle Williams; Walter A Koltun; Christopher S Hollenbeak; Evangelos Messaris Journal: J Gastrointest Surg Date: 2020-01-21 Impact factor: 3.452
Authors: Florence E Turrentine; Timothy L McMurry; Mark E Smolkin; R Scott Jones; Victor M Zaydfudim Journal: J Gastrointest Surg Date: 2021-05-04 Impact factor: 3.452