Variation in physician spending and its association with postoperative outcomes among patients undergoing surgery for gastrointestinal cancer

Abstract

BackgroundThere is significant variation in inpatient expenditures among physicians and hospitals. This study aimed to characterize the association between variation in physician spending and short-term outcomes among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC) and colorectal cancer (CRC). MethodsPatients who underwent surgery for PDAC and CRC from 2010 to 2020 were identified using the Surveillance, Epidemiology, and End Result-Medicare–linked database. The cohort was divided into quartiles based on adjusted physician spending, and multivariate models were used to assess the association between physician spending and patient outcomes. ResultsAmong 27,596 Medicare beneficiaries, 25,615 (92.8%) underwent surgery for CRC and 1981 (7.2%) underwent surgery for PDAC. Of the variations in spending, 79.9% were due to patient-level factors, 13.3% were due to hospital characteristics, and 6.8% were due to surgeon-level variables. On multivariate analysis, there was no association between physician spending and 30-day readmission (with complications: first quartile [Q1], reference; Q4: odds ratio [OR], 1.10; 95% CI, 0.86–1.41; P = .123; without complications: Q1, reference; Q3, stage IV: OR, 0.97; 95% CI, 0.68–1.40; P = .882) or between physician spending and 30-day mortality (without complications: Q1, reference; Q2, stage I: OR, 1.17; 95% CI, 0.45–3.01; P = .804). However, an increase in physician spending was associated with higher 30-day mortality among patients with complications (Q1, reference; Q4: OR, 2.28; 95% CI, 1.72–3.03; P < .001). ConclusionThere was more variation in healthcare spending across hospitals than across individual physicians. No consistent association between variation in physician spending and patient outcomes was noted. Wasteful spending can be reduced through targeted interventions aimed at reducing variations at the physician and hospital levels.