The cost of Pancreatoduodenectomy - An analysis of clinical determinants.
BACKGROUND
Health care spending is increasing the world over. Determining preventable or correctable factors may offer us valuable insights into developing strategies aimed at reducing costs and improving patient care. The aim of this study was to conduct an exploratory analysis of clinical factors influencing costs of Pancreatoduodenectomy (PD).


METHODS
The financial and clinical records of 173 consecutive patients who underwent PD at a tertiary care referral centre, between January 2013 and June 2015 were analysed.


RESULTS
Complications, by themselves, did not increase costs associated with PD unless they resulted in an increase in the duration of stay more than 11 days. Intraoperative blood transfusion (p-.098) and performance of an end-to-side PJ (p-.043) were independent factors significantly affecting costs. Synchronous venous resections significantly increased costs (p-.006) without affecting duration of stay. Advancing age, hypertension, neurological and respiratory disorders, preoperative endoscopic retrograde cholangiopancreatography (ERCP), performance of a feeding jejunostomy, and surgical complications eg PPH, POPF and DGE significantly increased the duration of stay sufficient enough to influence costs of PD.


CONCLUSIONS
It is not the merely the development, but severity of complications that significantly increase the cost of PD by increasing hospital stay. Strategies aimed at reducing intraoperative blood transfusion requirement as well as minimising the development of POPF can help reduce costs. Synchronous venous resections significantly increase costs independent of hospital stay. This study identified nine factors that may be included in the development of a preoperative nomogram that could be used in preoperative financial counselling of patients undergoing PD.
Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
Savio George
SG
Barreto
Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
Amanjeet
A
Singh
Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
Azhar
A
Perwaiz
Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
Tanveer
T
Singh
Medical Administration, Medanta, The Medicity, Gurgaon, India.
Rohini
R
Adlakha
Department of Clinical Research, Medanta, The Medicity, Gurgaon, India.
Manish Kumar
MK
Singh
Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India. Electronic address: adarsh_chaudhary@yahoo.com.
Adarsh
A
Chaudhary
D001803:Blood Transfusion / Q000191:economics; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics; D003695:Delivery of Health Care; D005746:Gastric Emptying; D006801:Humans; D007194:India; D007430:Intraoperative Care / Q000191:economics; D007902:Length of Stay; D010185:Pancreatic Fistula / Q000191:economics / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000191:economics
Morbidity; Mortality; Nomogram; Outcomes; Quality; Surgery