A PROSPECTIVE COST-ANALYSIS OF PANCREATICODUODENECTOMY

BACKGROUND: In our cost-conscious health care system hospitals are fin ding that costs are as important as charges or reimbursements, especia lly as hospitals compete for managed care contracts, We have prospecti vely gathered cost data for more than 60 common operations performed a t our institution over the last 3 years. METHODS: Over a 25-month peri od, from January 1993 to February 1995, 30 pancreaticoduodenectonay pr ocedures were performed for which cost data were available, Cases were divided according to diagnosis (neoplastic or benign) and were evalua ted for complications which prolonged length of slay (LOS). Costs were analyzed by an item-by-item prospective micro-cost analysis technique , Items were grouped into two areas: operating room (OR) costs and hos pital (ward) costs, OR costs included disposable equipment, nondisposa ble equipment, OR room, OR staff, postanesthesia care, and anesthesia costs, Ward costs included hospital room, pharmacy, and radiology cost s. RESULTS: OR costs for the 30 PD patients were similar and represent ed approximately 21% of total hospital costs, Of the 30 patients, comp lications resulting in a prolonged LOS occurred in 10 (33%): intra abd ominal abscess in 3 (2 with pancreatic leaks), superficial marginal ul ceration in 2, delayed return of gastrointestinal function in 2 (1 wit h pulmonary edema) nd 1 each of bile leak, urosepsis, and chylous asci tes, No cost differences were observed when comparing neoplasm versus chronic pancreatitis for all parameters. When comparing patients who h ad complications versus those who did not, however, there was a statis tically significant cost difference for both hospital ward or total co sts, Regardless of whether a PD was performed for neoplastic or benign disease, postoperative complications increased hospital ward costs by 76% due Po increased LOS. CONCLUSIONS: This cast analysis study is an example of the methodology that would allow surgeons to investigate a ny common surgical procedure by first identifying areas of increased c osts, This quantitative knowledge focuses the clinician on areas to im prove quality which will then lower costs.