Counting the Cost: Financial Implications of Complications Following Pancreaticoduodenectomy

Abstract

Introduction: Post-operative morbidity rates for pancreaticoduodenectomy (PD) have been reported as high as 30-45%. These complications can nearly double hospital costs. We sought to explore the financial implications of major complications after PD in a large institutional database. Methods: A retrospective analysis of consecutive patients undergoing PD between 2010-2017 was performed. Hospital costs for index hospitalization were divided into 4 categories; Operating room (OR), post-operative ward care (PO), radiology imaging (RAD) and interventional procedures with radiology or GI (IR). Complications were categorized as major or minor according to the Clavien-Dindo classification. Univariate and multivariate regression analysis was performed. Significance was reported for p<0.05. Results: Cost data for 998 patients was included. Median cost of index admission for PD was $23,704 (range $13,611-517,543). Patients with major complications incurred significantly greater mean costs compared to those without ($57,732 vs $30,259, p<0.01). Patients with post-operative pancreatic fistula (POPF) grade A, B and C had progressively increasing costs respectively [32,164 (± 13,053), 50,264 (± 30,883) and 102,013 (± 107,484), p<0.01]. On multivariate regression analysis, POPF grade B and C, thromboembolic events, reoperation and respiratory failure were associated with significantly increased costs of admission. Conclusions: This study identifies the major contributors towards increased cost after PD. Major complications such as POPF and thromboembolic events can significantly increase the costs of index admission. Initiatives that focus on prevention of these complications could potentially reduce healthcare costs associated with complications after POPF and help reduce the financial burden on both patients and healthcare organizations.