The true cost of high volume whipple procedures

Abstract

Background: Previous studies of Whipple procedures have shown improved outcomes and lower cost at high volume centers. The purpose of this study was to evaluate outcomes and costs at high volume centers while including readmissions and readmissions to different hospitals. Methods: The Nationwide Readmissions Database was queried for patients undergoing a radical pancreaticoduodenectomy. The total cost of each admission and readmission was calculated by using the cost to charge ratio provided by the database. High volume centers were identified as performing in the highest quartile of Whipple procedures. Outcomes of interest were in-hospital mortality, prolonged length of stay (LOS) >30 days, readmission within 30 days, and readmission to a different hospital. Univariable analysis and multivariable logistic regression were performed. Results were weighted for national estimates. Results: There were 48,062 patients undergoing a Whipple procedure. Total admission cost was $421 million per year. Mean cost of index admission was lower at high volume centers ($41,870 [±40,088] versus $51,164 [±44,749], p < 0.01). An additional $38 million per year was spent on readmissions within 30 days. The readmission rate was 21.9% and the readmission occurred at a different hospital in 12.0%. High volume hospitals had a decreased risk for mortality (0.67, p < 0.01) and prolonged LOS (OR 0.45, p < 0.01). Mean LOS was lower at high volume hospitals (13.2 [±11.0] versus 18.1 [±14.6] days, p < 0.01). High volume hospitals had an increased risk for readmission (OR 1.17, p < 0.01) and readmission to a different hospital (OR 1.75, p < 0.01). Conclusion: Whipple procedures performed at high volume centers are associated with improved outcomes and lower cost. However, these hospitals have higher readmission rates and are at risk for missing readmissions to different hospitals and the associated cost.