title: An economic analysis of pancreaticoduodenectomy: should costs drive consumer decisions?
abstract: BACKGROUND
  Consumer groups campaign for cost transparency believing that patients will select hospitals accordingly. We sought to determine whether the cost of pancreaticoduodenectomy (PD) should be considered in choosing a hospital.
  
  
  METHODS
  Using the Nationwide Inpatient Sample database, we analyzed charges for patients who underwent PD from 2000 to 2010. Outcomes were stratified by hospital volume.
  
  
  RESULTS
  A total of 15,599 PDs were performed in 1,186 hospitals. The median cost was $87,444 (interquartile range $16,015 to $144,869). High volume hospitals (HVH) had shorter hospital stay (11 vs 15 days, P < .001) and mortality (3% vs 7.6%, P < .001). PD performed at low volume hospitals had higher charges compared with HVH ($97,923 vs $81,581, P < .001). On multivariate analysis, HVH was associated with a lower risk of mortality, while extremes in hospital costs, cardiac comorbidity, and any complication were significant predictors of mortality.
  
  
  CONCLUSIONS
  Although PDs performed at HVH are associated with better outcomes and lower hospital charges, costs should not be the primary determinant when selecting a hospital.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3680D, Stanford, CA 94305, USA.
authors.forename: Thuy B
authors.initials: TB
authors.lastname: Tran
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3680D, Stanford, CA 94305, USA.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Dua
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3680D, Stanford, CA 94305, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Worhunsky
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3680D, Stanford, CA 94305, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3680D, Stanford, CA 94305, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3680D, Stanford, CA 94305, USA. Electronic address: bvisser@stanford.edu.
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
mesh_terms: D000368:Aged; D002140:California; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000191:economics* / Q000379:methods; D057240:Patient Preference / Q000191:economics*; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States
keywords: Complication; Cost analysis; Hospital charges; Hospital volume; Pancreaticoduodenectomy; Whipple