title: Pancreas fistula risk prediction: implications for hospital costs and payments.
abstract: As payment models evolve, disease-specific risk stratification may impact patient selection and financial outcomes. This study sought to determine whether a validated clinical risk score for post-operative pancreatic fistula (POPF) could predict hospital costs, payments, and profit margins.
  
  
  
  A multi-institutional cohort of 1193 patients undergoing pancreaticoduodenectomy (PD) were matched to an independent hospital where cost, in US$, and payment data existed. An analytic model detailed POPF risk and post-operative sequelae, and their relationship with hospital cost and payment.
  
  
  
  Per-patient hospital cost for negligible-risk patients was $37,855. Low-, moderate-, and high- risk patients had incrementally higher hospital costs of $38,125 ($270; 0.7% above negligible-risk), $41,128 ($3273; +8.6%), and $41,983 ($3858; +10.9%), respectively. Similarly, hospital payment for negligible-risk patients was $42,685/patient, with incrementally higher payments for low-risk ($43,265; +1.4%), moderate-risk ($45,439; +6.5%) and high-risk ($46,564; +9.1%) patients. The lowest 30-day readmission rates - with highest net profit - were found for negligible/low-risk patients (10.5%/11.1%), respectively, compared with readmission rates of moderate/high-risk patients (15%/15.7%).
  
  
  
  Financial outcomes following PD can be predicted using the FRS. Such prediction may help hospitals and payers plan for resource allocation and payment matched to patient risk, while providing a benchmark for quality improvement initiatives.
authors.affiliation: University of Wisconsin, USA. Electronic address: abbott@surgery.wisc.edu.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: University of Texas MD Anderson Cancer Center, USA.
authors.forename: Ching Wei D
authors.initials: CW
authors.lastname: Tzeng
authors.affiliation: University of Pennsylvania, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: McMillan
authors.affiliation: Beth Israel Deaconess Medical Center, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.affiliation: Beth Israel Deaconess Medical Center, USA.
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.affiliation: University of Alabama-Birmingham, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Christein
authors.affiliation: University of Tennessee, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Behrman
authors.affiliation: University of Cincinnati, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Schauer
authors.affiliation: University of Cincinnati, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: University of Cincinnati, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
authors.affiliation: University of Pennsylvania, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D015276:Health Care Rationing / Q000191:economics; D005102:Health Expenditures / Q000592:standards; D006301:Health Services Needs and Demand / Q000191:economics; D017721:Hospital Costs / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D018803:Models, Economic; D020380:Needs Assessment / Q000191:economics; D010185:Pancreatic Fistula / Q000191:economics* / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality / Q000592:standards; D010359:Patient Readmission / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics* / Q000592:standards; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States