Factors Associated With Interhospital Variability in Inpatient Costs of Liver and Pancreatic Resections.
OBJECTIVE
In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending.


OBJECTIVE
To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in the United States.


METHODS
Retrospective analysis of total costs among 42 480 patients undergoing hepatopancreaticobiliary surgery from January 1, 2002, through December 31, 2011, using a nationally representative data set (Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project). Analysis was conducted in May 2015.


METHODS
Total inpatient costs and proportional variation in inpatient costs among individual hospitals.


RESULTS
Among the 42 480 patients who underwent liver or pancreatic resection, the median age was 62 years, 52.4% were female, and 72.9% had a Charlson Comorbidity Index of 2 or higher. The median cost for the entire cohort was $21,535 (interquartile range, $15,373-$31,104), varying from $3320 to $279,102 among individual hospitals. On multivariable analysis, increasing patient comorbidity (coefficient, 2000.30; 95% CI, 1363.33-2637.27; P < .001) and operative characteristics (total pancreatectomy: coefficient, 12 742.31; 95% CI, 10 063.66-15 420.94; P < .001; lobectomy: coefficient, 6336.42; 95% CI, 3934.61-8737.24; P < .001) were associated with higher hospital costs. The development of postoperative complications, such as sepsis (coefficient, 30 571.25; 95% CI, 29 308.96-31 833.54; P < .001) or stroke (coefficient, 8925.34; 95% CI, 2801.38-15 049.30; P = .004), and a longer length of stay were most strongly predictive of higher inpatient cost (length of stay >14 days: coefficient, 44 162.24; 95% CI, 43 125.56-45 198.92; P < .001). After adjusting for patient and hospital characteristics, the overall cost of hepatopancreaticobiliary surgery varied by $9000 among individual hospitals.


CONCLUSIONS
Significant variability was noted in hospital costs among patients undergoing pancreatic and liver surgery. Future policies should focus on reducing variations in costs by promoting payment paradigms that support a better quality of care and lower costs.
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Howard
H
Nelson-Williams
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Faiz
F
Gani
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Arman
A
Kilic
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Gaya
G
Spolverato
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Yuhree
Y
Kim
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Doris
D
Wagner
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neda
N
Amini
Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago.
Aslam
A
Ejaz
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Timothy M
TM
Pawlik
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006498:Hepatectomy / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000191:economics*; D012189:Retrospective Studies