title: Implications and cost of pancreatic leak following distal pancreatic resection.
abstract: OBJECTIVE
  Pancreatic stump leak (PL) after elective distal pancreatic resection significantly impacts cost and increases subsequent health care resource utilization. We sought to provide an economic framework for potential interventions aimed at reducing its occurrence.
  
  
  METHODS
  Retrospective case series and economic evaluation.
  
  
  METHODS
  University-affiliated, tertiary care referral center.
  
  
  METHODS
  Sixty-six patients undergoing elective distal pancreatectomy.
  
  
  METHODS
  Postoperative complications; hospital and professional costs.
  
  
  RESULTS
  Overall postoperative morbidity occurred in 34 patients (52%) with no deaths. The total number of patients with complications directly related to PL was 22 (33%). The mean +/- SD number of total hospital days for the no-PL group was 5.2 +/- 1.7 days (range, 3-12 days) vs 16.6 +/- 14.6 days (range, 4-49 days) for the PL group (P = .001). The average patient with PL-related problems incurred a total cost that was 2.01 times greater than the average patient in the no-PL group. A decision analytic model developed to evaluate threshold costs showed that a hypothetical intervention designed to reduce the complication rate of distal pancreatectomy by one third would be financially justifiable up to a cost of $1418 per patient.
  
  
  CONCLUSIONS
  Complications derived from PL following distal pancreatectomy double the cost and dramatically increase health care resource utilization. There is an urgent need to develop strategies that reduce the incidence of this common complication. Interventions aimed at decreasing the incidence of PL should take into account this cost differential. We provide an economic model to serve as a guide for developing these technologies.
authors.affiliation: Center for Clinical Effectiveness in Surgery, Harvard Medical School, Boston, USA.
authors.forename: J Rubén
authors.initials: JR
authors.lastname: Rodríguez
authors.forename: Santos Soto
authors.initials: SS
authors.lastname: Germes
authors.forename: Pari V
authors.initials: PV
authors.lastname: Pandharipande
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Thayer
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-del Castillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000191:economics* / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics*; D012189:Retrospective Studies