Jason Wang1, Ronald Ma2, Paul Eleftheriou3, Leonid Churilov4, David Debono5, Ray Robbins5, Mehrdad Nikfarjam6, Chris Christophi6, Laurence Weinberg7. 1. University of Melbourne, Department of Anaesthesia, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia. 2. Department of Finance, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia. 3. Chief Medical Office, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia. 4. Statistics and Decision Analysis Academic Platform, Florey Institute of Neuroscience & Mental Health, Melbourne Brain Centre, Austin Campus, Heidelberg, VIC 3084, Australia. 5. Business Intelligence Unit, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia. 6. Department of Surgery, University of Melbourne, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia. 7. University of Melbourne, Department of Anaesthesia, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia; Department of Surgery, University of Melbourne, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia. Electronic address: laurence.weinberg@austin.org.au.
Abstract
BACKGROUND: A cost analyses of complications following pancreaticoduodenectomy (PD) was performed in a high volume hepato-biliary-pancreatic service. We hypothesised that costs are increased with both severity and number of complications; we investigated the relationship between complications and specific cost centres. METHODS: 100 patients from 2011 to 2016 were included. Data relating to their perioperative course were collected. Complications were documented by the Clavien-Dindo classification and costs were inflated and converted to 2017 USD. RESULTS: Mean hospital costs in complicated patients more than doubled those of uncomplicated patients ($28 330 vs. $57 150, p < 0.0001). Total hospital costs significantly increased with both severity and number of complications. This cost increase was influenced by medical consult, pathology, pharmacy, radiology, ward, intensive care, and allied health costs, but not operating theatre or anaesthesia costs. Postoperative pancreatic fistula, postoperative haemorrhage, delayed gastric emptying and infection were associated with cost differentials of $65 438, $74 079, $35 620 and $46 316 respectively over uncomplicated patients. CONCLUSION: The development of complications following PD is common, costly and associated with increased length of stay. Costs increased with greater complication severity, and specific complications. The in-depth breakdown of hospital costs suggests specific targets for cost containment.
BACKGROUND: A cost analyses of complications following pancreaticoduodenectomy (PD) was performed in a high volume hepato-biliary-pancreatic service. We hypothesised that costs are increased with both severity and number of complications; we investigated the relationship between complications and specific cost centres. METHODS: 100 patients from 2011 to 2016 were included. Data relating to their perioperative course were collected. Complications were documented by the Clavien-Dindo classification and costs were inflated and converted to 2017 USD. RESULTS: Mean hospital costs in complicated patients more than doubled those of uncomplicated patients ($28 330 vs. $57 150, p < 0.0001). Total hospital costs significantly increased with both severity and number of complications. This cost increase was influenced by medical consult, pathology, pharmacy, radiology, ward, intensive care, and allied health costs, but not operating theatre or anaesthesia costs. Postoperative pancreatic fistula, postoperative haemorrhage, delayed gastric emptying and infection were associated with cost differentials of $65 438, $74 079, $35 620 and $46 316 respectively over uncomplicated patients. CONCLUSION: The development of complications following PD is common, costly and associated with increased length of stay. Costs increased with greater complication severity, and specific complications. The in-depth breakdown of hospital costs suggests specific targets for cost containment.
Authors: Luka Cosic; Ronald Ma; Leonid Churilov; David Debono; Mehrdad Nikfarjam; Christopher Christophi; Laurence Weinberg Journal: Medicine (Baltimore) Date: 2019-07 Impact factor: 1.817