title: Costs of hepato-pancreato-biliary surgery and readmissions in privately insured US patients.
abstract: BACKGROUND
  Surgical costs are influenced by perioperative care, readmissions, and further therapies. We aimed to characterize costs in hepato-pancreato-biliary surgery in the United States.
  
  
  METHODS
  The MarketScan database (2008-2010) was used to identify privately insured patients undergoing pancreatectomy (n = 2254) or hepatectomy (n = 1702). Costs associated with the index surgery, readmissions, and total short-term costs were assessed from a third party payer perspective using generalized linear regression models.
  
  
  RESULTS
  Mean total costs of pancreatectomy and hepatectomy were $107,600 (95% confidence interval [CI], 101,200-114,000) and $81,300 (95% CI, 77,600-85,000), respectively, with corresponding surgical costs of 69.2% and 60.9%. Ninety-day readmission costs were $36,200 (95% CI, 32,000-40,400) and $34,100 (95% CI, 28,100-40,100), respectively. In multivariate analysis, readmissions were associated with an almost two-fold increase in total costs in both pancreatectomy (cost ratio = 1.98; P < 0.001) and hepatectomy (cost ratio = 1.92; P < 0.001).
  
  
  CONCLUSIONS
  Hepato-pancreato-biliary surgery is associated with significant economic burden in the privately insured population. Substantial costs are incurred beyond the index surgical admission, with readmissions representing a major source of potentially preventable health care spending. Sustained efforts in defining high-risk populations and decreasing the burden of postoperative complications through a combination of prevention and improved outpatient management offer promising strategies to reduce readmissions and control costs.
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.affiliation: Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Cooper
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. Electronic address: ngusani@psu.edu.
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
mesh_terms: D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000191:economics*; D006801:Humans; D007341:Insurance; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000191:economics*; D010359:Patient Readmission / Q000191:economics*; D014481:United States; D055815:Young Adult
keywords: Costs; Economic; Hepatectomy; MarketScan; Pancreatectomy; Readmission