title: Financial Impact of Postoperative Complication Following Hepato-Pancreatico-Biliary Surgery for Cancer.
abstract: BACKGROUND
  Despite increasing efforts for cost containment, little is known regarding the financial implications of postoperative complication under current volume-driven payment paradigms. This study sought the test the associations between hospital finances and postoperative complications among hepato-pancreatico-bilary cancer patients.
  
  
  METHODS
  Patients undergoing surgery for the management of a hepatobiliary or pancreatic cancer between January 1, 2009 and December 31, 2013 were identified using institutional claims and cost-accounting data. Multivariable linear regression analyses were used to calculate risk-adjusted fixed and variable costs, payments, and net margins.
  
  
  RESULTS
  A total of 1483 met inclusion criteria. Fixed ($9290 [interquartile range (IQR) $7129-$11,598] vs. $14,784 [IQR $10,523-$22,799], p < 0.001) and variable costs ($12,342 [IQR $9886-$14,762] vs. $19,330 [IQR $13,967-$29,435], p < 0.001) were higher among patients who developed a postoperative complication following a hepatectomy. A higher contribution margin ($12,421 [IQR $8440-$16,445] vs. $20,016 [IQR $14,212-$39,179], p < 0.001), as well as a twofold higher net profit was noted among patients who developed postoperative complication ($2788 [IQR $660-$5815] vs. $5515 [IQR $1068-$10,315], p < 0.001). Total hospital costs ($26,840 [IQR $21,318-$35,358] vs. $46,628 [IQR $31,974-$69,326], p < 0.001) as well as payments ($32,761 [IQR $26,394-$41,883] vs. $53,612 [IQR $38,548-$78,116], p < 0.001) were more than 1.5 times higher among patients who developed a postoperative complication following pancreatic resection. Contribution margins ($18,356 [IQR $14,024-$24,390] vs. $29,153 [IQR $20,256-$41,785], p < 0.001), as well as net profits ($5907 [IQR $2179-$9412] vs. $8114 [IQR $2518-$14,249], p < 0.001) were higher among patients who developed postoperative complication following pancreatic surgery.
  
  
  CONCLUSIONS
  A positive association was observed between net profits and postoperative complications. Future policies should target complications as a means to achieving a higher value for care.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hundt
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate