Hospital cost-categories of pancreaticoduodenectomy

In the era of cost-conscious healthcare, hospitals are focusing on costs. Analysis of hospital costs per cost-category may provide indications for potential cost saving measures in pancreaticoduodenectomy (PD).

Between January 2004 and June 2005, 109 consecutive patients underwent curative PD for a pancreatic or peri-ampullary tumour. Costs were defined in different cost categories for each activity centre and were linked to the individual patient via the 'bill of activities'.

Postoperative complication rate was 46.8%, postoperative pancreatic fistula (POPF) 12.8%, and mortality rate 1.8%. The overall median LOS was 17 (range 7-52) days. The length of hospital stay (LOS) was significantly (p < 0.0001) different between patients with POPF, those with other complications, and patients without complications i.e. 26 (10-36) vs. 21 (8-52) vs. 14 (7-33) days, respectively. Median hospital cost per patient was 10406 (5570-30999) euros. The total hospital costs were significantly related to the LOS (p < 0.0001). The increase of total hospital costs was influenced by the hospitalization (p < 0.0001) and medical staff (p < 0.0001) costs, but not by the cost for the operation room (p = 0.233).

Postoperative complications, in particular POPF, are associated with increased LOS and higher hospital costs. Any measure to reduce the incidence and severity of complications after PD will save hospital costs.