The Price of a Whipple: Predicting Hospital Charges Using Preoperative Patient Characteristics

Whipple's pancreaticoduodenectomy (PD) is a highly complex hepato-pancreato-biliary (HPB) procedure associated with substantial morbidity and cost. Although postoperative complications are known to increase healthcare expenditures, few studies have explored the association between preoperative factors and healthcare costs. This study evaluated the predictive value of baseline patient characteristics and preoperative laboratory tests in estimating index admission charges for Whipple's PD.

A retrospective review of 375 patients who underwent open PD (2018-2023) at a high-volume, non-university tertiary care center was conducted. Preoperative demographics, comorbidities, laboratory values, and index admission hospital charges were analyzed. Univariate logistic regression identified significant predictors of charges, and the Kruskal-Wallis test was used to assess the relationship between cumulative preoperative indicators and charges.

Six preoperative laboratory values were significantly associated with increased charges: white blood cell count, hemoglobin, serum albumin, platelet count, prothrombin time, and hemoglobin A1c. A significant association was found between the cumulative preoperative indicators and hospital charges (p = 0.001). Patients with three or more unfavorable preoperative indicators incurred significantly higher charges compared to those with fewer than three indicators (p < 0.001).

Preoperative laboratory tests, many of which are modifiable, are significant predictors of hospital charges in patients undergoing PD. A higher cumulative burden of adverse preoperative indicators is associated with higher financial charges. These findings support the use of preoperative risk stratification and optimization to enhance value-based care, guide resource allocation, and mitigate financial toxicity in high-risk surgical patients.