Hospital costs associated with complications following pancreatoduodenectomy: systematic review

Pancreatoduodenectomy is associated with postoperative complications in nearly half of all patients. Understanding the financial burden of these complications is relevant to supporting initiatives to improve patient outcome and resource allocation. A contemporary systematic review evaluating the costs of complications following pancreatoduodenectomy is lacking.

A systematic review was conducted following PRISMA 2020 guidelines in PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception to September 2024. Studies reporting on the hospital costs (primary outcome) of complications following pancreatoduodenectomy were included. Costs were adjusted for inflation and purchasing power parity to 2023 Dutch euros (€). Data extraction and risk-of-bias assessments were conducted independently by two reviewers.

Overall, 46 studies with 111 215 patients undergoing pancreatoduodenectomy from 13 countries were included. Postoperative pancreatic fistula grade B increased costs by €1998 to €25 228, and grade C by €21 268 to €112 824 versus no clinically relevant postoperative pancreatic fistula (mean or median values). Delayed gastric emptying grade B increased costs by €10 836 to €22 571 and grade C by €28 707 to €61 818 versus no clinically relevant delayed gastric emptying. Postpancreatectomy haemorrhage (various definitions) increased costs by €29 447 to €48 380. Biliary leak grade B increased costs by €7616 and grade C by €22 727. Clavien-Dindo complication grade III added €2785 to €20 294 compared with grade II, and grade IV added €25 190 to €63 644 compared with grade III.

Complications following pancreatoduodenectomy increase costs substantially, exceeding €100 000 for a single postoperative pancreatic fistula grade C. These costs can now be used to design cost-effective prophylactic and therapeutic interventions aiming to improve patient outcomes together with optimal use of healthcare resources.