Outcomes of pancreaticoduodenectomy: where should we focus our efforts on improving outcomes?
OBJECTIVE
Changes in health care reimbursement policy have led to an era in which hospitals are motivated to improve quality of care while simultaneously reducing costs. Research demonstrating the most efficient means to target costs may have a positive effect on patient quality of life and the overburdened health care system.


OBJECTIVE
To evaluate the effect of hospital length of stay (LOS) and the occurrence of postoperative complications on total charges in patients undergoing elective pancreaticoduodenectomy.


METHODS
We performed a retrospective review of 89 cases identified in an institutional database of patients who underwent elective pancreaticoduodenectomy at an academic tertiary care center from December 1, 2007, through May 31, 2012.


METHODS
Occurrence of postoperative and inpatient complications, LOS, incidence of readmission within 60 days of discharge, and hospital charges from initial postoperative hospitalization. Linear regression analysis was performed comparing LOS with hospital charges.


RESULTS
Thirty-four of 89 patients (38%) developed postoperative complications. Mean and median LOSs were 12 and 8 days, respectively. The LOS was significantly related to postoperative complications. Of the 34 patients who developed complications, the mean LOS was 19 days compared with 7 days for those patients not developing complications (P < .001). Only 2 of 55 patients (4%) without complications were readmitted to the hospital, whereas 13 of 34 patients (38%) with complications required readmission. Perioperative hospital charges were significantly related to LOS (R² = 0.840, R = 0.917). For those patients without complications, linear regression demonstrated a daily hospital charge of $11,612 (R² = 0.923, R = 0.961). However, for those patients with complications, the optimal relationship between LOS and hospital charges was exponential (R² = 0.832).


CONCLUSIONS
Prolonged LOS is associated with increased total charges, but given the exponential increase in charges, the complication itself has an effect on increased charges above and beyond that of a prolonged hospitalization. The drive to reduce LOS after pancreaticoduodenectomy has minimal effect on overall charges to the patient. Efforts should be directed instead at reducing complications because this has a much more significant effect on financial outcomes.
Division of Surgical Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
Erin G
EG
Brown
Division of Surgical Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
Anthony
A
Yang
Division of Surgical Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
Robert J
RJ
Canter
Division of Surgical Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
Richard J
RJ
Bold
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017722:Hospital Charges; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome