Variation in Cost Centers Following Gastrointestinal Cancer Surgery

Despite cost-standardization efforts, significant variations in hospital costs persist in insurance claims. We sought to identify and quantify factors driving cost variability at hospital and cost center levels following a complex gastrointestinal surgical procedure.

Individuals who underwent pancreatectomy (PA), colectomy (CO), and proctectomy (PR) were identified from the Surveillance, Epidemiology, and End Results database. Index surgery costs across 1,262 hospitals were compared, adjusting for clinical, demographic, and geographic factors. Multilevel regression modeling identified factors associated with variability in charges.

Among 35,908 individuals (PA: 8.2%; CO: 79.4%; PR: 12.4%), the median age was 78 years (interquartile range [IQR] 72-84), with 56.1% male. Median Medicare payments varied significantly by cancer type (CO: $21,704, PA: $26,709, PR: $21,228; p < 0.001). Operating room ($6,891, 23.82%), hospital stay ($5,931, 20.9%), and professional fees ($4,352, 15.35%) were the top cost centers, comprising 60% of total costs. Surgeons had the highest charges (PA: $2,037; CO: $2,131; PR: $2,243), followed by anesthesiologists (PA: $622; CO: $431; PR: $480). Charges for critical care specialists and pathologists were relatively low. Multilevel modeling demonstrated total charge variability was primarily influenced by patient factors (83%), followed by surgeon factors (9%) and hospital factors (8%).

There was marked variation in spending at the cost center level in the surgical treatment of gastrointestinal cancers. Patient factors demonstrated the greatest variability, followed by hospital and surgeon-level factors. Implementing value-based healthcare and standardized surgical protocols may improve both care quality and cost-effectiveness.