An economic analysis of pancreaticoduodenectomy: should costs drive consumer decisions?

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• 作者：Thuy B. Tran ; M.D. ; Monica M. Dua ; M.D. ; David J. Worhunsky ; M.D. ; George A. Poultsides ; M.D. ; Jeffrey A. Norton ; M.D. ; Brendan C. Visser ; M.D. ; ^{bvisser@stanford.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cost analysis ; Hospital volume ; Pancreaticoduodenectomy ; Hospital charges ; Whipple ; Complication
• 刊名：The American Journal of Surgery
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：211
• 期：6
• 页码：991-997.e1
• 全文大小：329 K

文摘

Consumer groups campaign for cost transparency believing that patients will select hospitals accordingly. We sought to determine whether the cost of pancreaticoduodenectomy (PD) should be considered in choosing a hospital.

absSec_2">Methods

abspara0015">Using the Nationwide Inpatient Sample database, we analyzed charges for patients who underwent PD from 2000 to 2010. Outcomes were stratified by hospital volume.

absSec_3">Results

abspara0020">A total of 15,599 PDs were performed in 1,186 hospitals. The median cost was $87,444 (interquartile range $16,015 to $144,869). High volume hospitals (HVH) had shorter hospital stay (11 vs 15 days, P < .001) and mortality (3% vs 7.6%, P < .001). PD performed at low volume hospitals had higher charges compared with HVH ($97,923 vs $81,581, P < .001). On multivariate analysis, HVH was associated with a lower risk of mortality, while extremes in hospital costs, cardiac comorbidity, and any complication were significant predictors of mortality.

absSec_4">Conclusion

abspara0025">Although PDs performed at HVH are associated with better outcomes and lower hospital charges, costs should not be the primary determinant when selecting a hospital.