TY - JOUR
T1 - Defining the Price Tag of Complications Following Pancreatic Surgery
T2 - A US National Perspective
AU - Alterio, Rodrigo E.
AU - Meier, Jennie
AU - Radi, Imad
AU - Bhat, Archana
AU - Tellez, Juan C.
AU - Al Abbas, Amr
AU - Wang, Sam
AU - Porembka, Matthew
AU - Mansour, John
AU - Yopp, Adam C
AU - Zeh, Herbert J.
AU - Polanco, Patricio M.
N1 - Funding Information:
Work by PMP was supported by the Eugene P. Frenkel, M.D. Scholar in Clinical Medicine Program of UT Southwestern .
Publisher Copyright:
© 2023
PY - 2023/8
Y1 - 2023/8
N2 - Introduction: Pancreatic surgery tends to have a high rate of postoperative complications due to its complex nature, significantly increasing hospital costs. Our aim was to describe the true association between complications and hospital costs in a national cohort of US patients. Methods: The National Inpatient Sample was used to conduct a retrospective analysis of elective pancreatic resections performed between 2004 and 2017, categorizing them based on whether patients experienced major complications (MaC), minor complications (MiC), or no complications (NC). Multivariable quantile regression was used to analyze how costs varied at different percentiles of the cost curve. Results: Of 37,893 patients, 45.3%, 28.6%, and 26.1% experienced NC, MiC, and MaC, respectively. Factors associated with MaC were a Charlson Comorbidity Index of ≥4, prolonged length of stay, proximal pancreatectomy, older age, male sex, and surgery performed at hospitals with a small number of beds or at urban nonteaching hospitals (all P < 0.01). Multivariable quantile regression revealed significant variation in MiC and MaC across the cost curve. At the 50th percentile, MiC increased the cost by $3352 compared to NC while MaC almost doubled the cost of the surgery, increasing it by $20,215 (both P < 0.01). The association between complications and cost was even greater at the 95th percentile, increasing the cost by $10,162 and $108,793 for MiC and MaC, respectively (P < 0.01). Conclusions: MiC and MaC were significantly associated with increased hospital costs. Furthermore, the relationship between MaC and costs was especially apparent at higher percentiles of the cost curve.
AB - Introduction: Pancreatic surgery tends to have a high rate of postoperative complications due to its complex nature, significantly increasing hospital costs. Our aim was to describe the true association between complications and hospital costs in a national cohort of US patients. Methods: The National Inpatient Sample was used to conduct a retrospective analysis of elective pancreatic resections performed between 2004 and 2017, categorizing them based on whether patients experienced major complications (MaC), minor complications (MiC), or no complications (NC). Multivariable quantile regression was used to analyze how costs varied at different percentiles of the cost curve. Results: Of 37,893 patients, 45.3%, 28.6%, and 26.1% experienced NC, MiC, and MaC, respectively. Factors associated with MaC were a Charlson Comorbidity Index of ≥4, prolonged length of stay, proximal pancreatectomy, older age, male sex, and surgery performed at hospitals with a small number of beds or at urban nonteaching hospitals (all P < 0.01). Multivariable quantile regression revealed significant variation in MiC and MaC across the cost curve. At the 50th percentile, MiC increased the cost by $3352 compared to NC while MaC almost doubled the cost of the surgery, increasing it by $20,215 (both P < 0.01). The association between complications and cost was even greater at the 95th percentile, increasing the cost by $10,162 and $108,793 for MiC and MaC, respectively (P < 0.01). Conclusions: MiC and MaC were significantly associated with increased hospital costs. Furthermore, the relationship between MaC and costs was especially apparent at higher percentiles of the cost curve.
KW - Cost of complications
KW - Pancreatic surgery
KW - Postoperative complications
KW - Quantile regression
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U2 - 10.1016/j.jss.2023.02.032
DO - 10.1016/j.jss.2023.02.032
M3 - Article
C2 - 36963298
AN - SCOPUS:85150801690
SN - 0022-4804
VL - 288
SP - 87
EP - 98
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -