Breakdown analysis of the cost development of pancreatic surgery after centralization

Centralization of pancreatic surgery has been shown to improve short-term outcomes and reduce postoperative mortality. Whether these clinical gains translate into lower costs is less clear, and evidence on the relationship between volume and cost remains inconsistent. In this study, we performed an itemized cost analysis of the pancreatic surgery process over the first decade following centralization. The primary objectives were to evaluate whether surgical costs have changed over time and to identify the main drivers of post-centralization costs.

The retrospective single-centre study included 403 consecutive patients who underwent pancreatic resections at Oulu University Hospital between 2013-2021. Clinicopathological variables were collected from patient records. Direct hospital costs were calculated using inflation-adjusted tariffs for various subcategories: operation room (OR) costs, ward days, intensive care unit (ICU) stay, radiological imaging, laboratory tests, endoscopies and interventional radiology procedures.

The median total cost per pancreatectomy patient was €23,521. The largest cost components were OR expenses (median €10,659) and the postoperative ward care (median €6,677). While complications (Clavien-Dindo III-V) significantly correlated with higher expenses (P<0.001), total costs per patient rose by €11,190 during the study period despite a stable complication rate. The most significant increases occurred in OR costs (€8,941 to €15,136) and ward costs (€4,480 to €7,450). Median hospital costs for patients who underwent vascular reconstructions were higher than for patients with no vascular reconstruction (€27,683 vs. €22,401, P<0.001), while complication rates did not differ (P=0.051). In quantile regression analysis, distal pancreatic resection was associated with lower costs than pancreatoduodenectomy in patients with no or minor complications (adjusted P<0.001). Associations between cost and vascular reconstruction among patients with major complications did not remain significant after correction for multiple testing.

Costs of pancreatic surgery rose steadily during the first decade following centralization, despite a stable complication rate. In quantile regression analysis, only procedure type remained a significant cost driver after correction for multiple testing. OR costs and postoperative ward care accounted for most of the rising expenses.