title: 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.
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.
authors.affiliation: Division of Surgical Oncology, East Carolina University, Brody School of Medicine, Greenville, NC, USA; Vidant Medical Center, Greenville, NC, USA.
authors.forename: Swapnil D
authors.initials: SD
authors.lastname: Kachare
authors.forename: Kendall R
authors.initials: KR
authors.lastname: Liner
authors.forename: Nasreen A
authors.initials: NA
authors.lastname: Vohra
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.forename: Todd
authors.initials: T
authors.lastname: Hickey
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017721:Hospital Costs; D061847:Hospitals, High-Volume; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D015999:Multivariate Analysis; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects / Q000191:economics*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult