1. Assessment of health care cost for complex surgical patients: review of cost, re-imbursement and revenue involved in pancreatic surgery at a high-volume academic medical centre.
- Author
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Kachare SD, Liner KR, Vohra NA, Zervos EE, Hickey T, and Fitzgerald TL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Medicare economics, Middle Aged, Models, Economic, Multivariate Analysis, Odds Ratio, Pancreatectomy adverse effects, Pancreaticoduodenectomy adverse effects, Postoperative Complications economics, Retrospective Studies, Risk Factors, Treatment Outcome, United States, Young Adult, Academic Medical Centers economics, Hospital Costs, Hospitals, High-Volume, Insurance, Health, Reimbursement economics, Pancreatectomy economics, Pancreaticoduodenectomy economics, Process Assessment, Health Care economics
- Abstract
Background: Pancreatic surgery is complex with the potential for costly hospitalization., Methods: A retrospective review of patients undergoing a pancreatic resection was performed., Results: The median age of the study population was 64 years. Half of the cohort was female (51%), and the majority were white (62%). Most patients underwent a pancreaticoduodenectomy (PD) (69%). The pre-operative age-adjusted Charlson comorbidity index was zero for 36% (n = 50), 1 for 31% (n = 43) and ≥2 for 33% (n = 45). The Clavien-Dindo grading system for post-operative complication was grade I in 17% (n = 24), whereas 45% (n = 62) were higher grades. The medians direct fixed, direct variable, fixed indirect and total costs were $2476, $15,397, $13,207 and $31,631, respectively. There was a positive contribution margin of $7108, whereas the net margin was a loss of $6790. On univariate analyses, age, type of operation and complication grade were associated with total cost (P ≤ 0.05), whereas operation type and complication grade were associated with a net margin (P = 0.01). These findings remained significant on multivariate analysis (P < 0.05)., Conclusions: Increased cost, reimbursement and revenue were associated with type of operation and post-operative complications., (© 2014 International Hepato-Pancreato-Biliary Association.)
- Published
- 2015
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