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Updated: Oct 5, 2025
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Counting the cost: financial implications of complications following pancreaticoduodenectomy
Mohammad Raheel Jajja1, Fatima Mustansir2, Syed O Nadeem2
1Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL USA.
Insights
Complications following pancreaticoduodenectomy (PD) significantly increase hospital costs. Preventing these issues can reduce financial burdens for patients and healthcare systems.
Area of Science:
- Surgical Oncology
- Health Economics
- Gastroenterology
Background:
- Morbidity rates after pancreaticoduodenectomy (PD) range from 30-53%.
- Complications following PD can significantly increase hospital expenditures.
- Understanding the financial impact of PD complications is crucial for healthcare management.
Purpose of the Study:
- To investigate the financial implications of complications after pancreaticoduodenectomy (PD).
- To identify specific complications that contribute most to increased costs post-PD.
Main Methods:
- Retrospective analysis of 997 patients undergoing PD between 2010-2017.
- Hospitalization costs categorized into operating room, postoperative ward, radiology, and interventional radiology.
- Complications classified using the Clavien-Dindo system; univariable and multivariable analyses performed.
Main Results:
- Median index admission cost was $23,704; major complications increased costs to $40,005.
- Postoperative pancreatic fistula (POPF) grades A, B, and C showed progressively higher costs ($32,164, $50,264, $102,013).
- Multivariable analysis linked ileus, respiratory failure, POPF, thromboembolism, reoperation, prolonged surgery, and male sex to increased costs.
Conclusions:
- Complications following PD substantially elevate hospital costs.
- This study pinpoints key drivers of increased post-PD expenses.
- Implementing complication prevention strategies can alleviate financial strain on patients and healthcare providers.
Background:
Morbidity after pancreaticoduodenectomy (PD) has been reported to be about 30-53%. These complications can double hospital costs. We sought to explore the financial implications of complications after PD in a large institutional database.
Methods:
A retrospective analysis of patients undergoing PD from 2010-2017 was performed. Costs for index hospitalization were divided into categories: operating room, postoperative ward, radiology and interventional radiology. Complications were categorized according to the Clavien-Dindo classification. Univariable and mutivariable analysis were performed.
Results:
Median cost of index admission for 997 patients who underwent PD was $23,704 (range $10,988-$528,531). Patients with major complications incurred significantly greater median costs compared to those without ($40,005 vs $21,306, p < 0.001). Patients with postoperative pancreatic fistula (POPF) grade A, B and C had progressively increasing costs ($32,164, $50,264 and $102,013, p < 0.001). On multivariable analysis ileus/delayed gastric emptying, respiratory failure, clinically significant POPF, thromboembolic complications, reoperation, duration of surgery >240 minutes and male sex were associated with significantly increased costs.
Conclusion:
Complications after PD significantly increase hospital costs. This study identifies the major contributors towards increased cost post-PD. Initiatives that focus on prevention of complications could reduce associated costs and ease financial burden on patients and healthcare organizations.
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