J. Hyer1, A. Paredes1, D. I. Tsilimigras1, A. Ejaz1, T. M. Pawlik1 1Ohio State University,Columbus, OH, USA
Introduction: The economic burden of liver and pancreatic surgery may be inadequately ascertained by assessing only the index hospitalization cost. Rather, the “true cost” of a surgical episode may be impacted by events that occur in the post-operative period. We sought to estimate the economic burden associated with total “episode of care” related to hepato-pancreatic (HP) surgery.
Methods: Patients who underwent HP resection between 2013-2015 were identified using 100% Medicare Standard Analytic Files. To assess economic burden, costs for the index hospitalization, as well as readmissions associated with a surgical complication, outpatient visits, as well as expenses related to skilled nursing facilities / home health care within 90 days were examined. Gamma regression with a log link was utilized to determine factors associated with economic burden.
Results: Among 21,737 patients who underwent a liver or pancreatic operation, median patient age was 72 (IQR: 68-77) years; approximately one-half of patients were male (50.6%; n=10,999) and median Charlson comorbidity index (CCI) was 4 (IQR: 2-8). The majority of cases were performed at a teaching hospital (75.2%; n=16,338); post-operatively, the incidence of a complication was 26.3% (n=5,716) and length-of-stay (LOS) was 7d (IQR: 5-12). Overall costs associated with index admission were $20,500 (IQR: $16,100-$34,300)(liver: $19,100, IQR: $15,100-$29,000 vs. pancreas: $22,100, IQR: $16,800-$36,500). Among the 6,435 (30%) patients who had an all-cause 90-day readmission, more than one-half (55.8%; n=3,589) were related to a complication secondary to the surgical procedure. Among patients with a readmission within 90 days, median costs were $13,280 (IQR: $8,400-$25,900)(liver: $12,900, IQR: $8,000-$24,200 vs. pancreas: $13,400, IQR: $8,600-$27,400). Median costs of other post-discharge episodes of care such as outpatient visits and post-discharge assistance were $1,600 (95%CI: $0-$3,800)(liver: $300, IQR: $0-$3,100 vs. pancreas: $2,000, IQR: $0-$4,100). Factors associated with higher additional costs included longer LOS, higher CCI, advanced age, Black/African-American race, and complication during index hospitalization (Table). In particular, patients who experienced a complication during index hospitalization had 28% higher costs (95%CI: 23.2%-33.1%) versus patients who did not experience a complication.
Conclusion: While the index admission was associated with the highest expenditure, many patients incurred additional surgery-related costs following surgery. Factors such as Black/African-American race and occurrence of post-operative complications were associated with increased risk of post-discharge increased costs.
