Analysis of 90-day readmission rates and healthcare cost in pancreatic surgery: what if bundled payment systems were applied to pancreatic surgery?

Abstract

Background: National efforts to curb healthcare spending, reduce waste and improve quality have led to the development of bundled payments systems by the Centers for Medicare and Medicaid for certain surgical procedures, e.g. joint replacements. Integral components of bundled payment metrics include length of stay (LOS), post-operative major complication (PMC) rates and unplanned readmission within a global period. The goal of this study was to quantify 90-day readmission and overall inpatient hospital costs in patients undergoing pancreatic surgery. Methods: A retrospective review of clinical and financial data was conducted on 413 patients undergoing pancreatic resection at a single academic institution. Data were analyzed using non-parametric testing to assess association between LOS, readmission rates and total inpatient hospital cost. Results: 104 patients (25%) required 90-day readmission after surgery and PMCs occurred in 15%. 87 required a single readmission (SRA) while 17 required multiple readmissions (MRA). Median LOS was 7 days in both SRA patients and those who did not require readmission (NRA). Median total index admission cost for patients was $24,788 (IQR = $14,189). Total hospital costs increased to $43,268 (IQR = $22,770) and $55,322 (IQR = $47,069) for the SRA and MRA groups, respectively. Patients requiring readmission were found to have higher index hospitalization costs compared to NRA patients, $29,566 vs. $23,947 (p = 0.01). Conclusion: Our results demonstrate that increased index hospitalization costs after pancreatic surgery are associated with higher 90-day readmissions with doubling of total global inpatient hospital costs. With changing reimbursement models, health-care providers performing pancreatic surgery need to pay attention to these national trends and quality metrics.