Economic impact of postoperative pancreatic fistula in pancreatic surgery.

Abstract

Background: Postoperative pancreatic fistula (POPF) is the most important complication after pancreatic surgery and is associated with major morbidity, increased use of resources, and prolonged hospital stay. The true economic impact of POPF is unknown. Methods: We evaluated the economic impact of POPF based on a full cost analysis of hospital expenses and reimbursements for all patients discharged after pancreatic resections at our center in 2015 with billing through the G-DRG-System. For definition and grading of POPF the 2016 update of the international definition was used. Uni- and multivariable analyses of factors associated with a deficit of >1000€ per case were performed. Results: Of 505 patients with pancreatic resections, 78 (15.4%) developed POPF. The occurrence and the grade of POPF were significantly associated with increased treatment costs in all cases and in subgroups of different resections (e.g. mean costs of 15,741.51€ without and of 54,023.20€ with POPF after pancreatoduodenectomy; p< 0.0001). DRG reimbursements significantly increased in parallel but failed to cover the cost increase. POPF resulted in uncovered costs and was associated with a deficit in total, after different resections, and within single DRGs. POPF was the dominant independent risk factor for deficits >1000€/case. Conclusion: POPF has considerable economic impact and results in highly increased treatment costs that are currently not covered by reimbursements through the G-DRG system.