Assessing post-discharge costs of hepatopancreatic surgery: an evaluation of Medicare expenditure

Abstract

BackgroundThe true cost of liver and pancreatic surgery may not be completely ascertained by examining costs associated solely with the index hospitalization. We sought to assess post-discharge costs related to liver and pancreatic surgery after the index hospitalization. MethodsWe identified Medicare beneficiaries who underwent liver and pancreatic resection between 2013 and 2015. To assess post-discharge costs, costs were assessed for the following: all inpatient readmissions associated with an operative complication, follow-up outpatient visits with their operating surgeon, and use of skilled nursing facilities, hospice, and home health care within 90 days of discharge. ResultsAmong the 21,737 patients who underwent either pancreatic or liver resection, the median cost of the index admission was $20,500 (interquartile range: $16,100–$34,300) (pancreas median: $22,100; interquartile range: $16,800–$36,500 vs liver median: $19,100; interquartile range: $15,100–$29,000). Approximately 30% (n = 6,435) had an all-cause readmission; more than half of readmissions (55.8%; n = 3,589) were related to an operative complication. Skilled nursing facilities and home health care services were utilized by 18.5% (n = 4,016) and 42.6% (n = 9,259) of patients, respectively. In total, nearly 75% of patients had additional, post-discharge hidden costs associated with their operative episode of care (n = 15,733: 72.4%). Male sex (95% confidence interval: 1.15–1.30) and black/African American race (95% confidence interval: 1.02–1.34) were associated with greater odds of post-discharge costs (both <0.05). ConclusionNearly 3 out of 4 patients who underwent a liver or pancreatic resection had post-discharge costs. Male and black/African American patients had greater odds of incurring post-discharge costs. As payers move to more bundled care payment models, strategies aimed at bending the cost curve associated with both the in-hospital, as well as the post-discharge setting, are needed.