ECONOMICS OF PANCREATICODUODENECTOMY IN THE ELDERLY

Background. Managed care and the increasing-percentage of surgical pro cedures performed in the elderly have renewed the focus on hospital ch arges and expenditures. The objective of this study was to determine w hether septuagenarians and octogenarians accrue more hospital charges or have a higher risk of morbidity and death. Methods. We retrospectiv ely reviewed the charges and pertinent clinical outcomes data that wer e available on 70 of the last 100 pancreatoduodenectomies performed at our institution (1989 to 1994). Charges from four cost centers were a nalyzed and normalized to 1995 dollars by using the Consumer Price Ind ex and Wilcoxon rank sum test. Patients were divided into two groups: group 1, 70 years of age or older (n = 21); group 2, younger than 70 y ears of age (n = 49). Results. Anesthetic charges were $2657 +/- $835 for group 1 versus $2815 +/- $826 for group 2, which was not a statist ically significant difference. Laboratory charges were $4650 +/- $3284 for group 1 versus $5969 +/- $5169 for group 2, which was not a signi ficant difference. Pharmaceutical charges were $5424 +/- $4435 for gro up 1 versus $9243 +/- $9695 for group 2, which was not a significant d ifference. Charges for operative units were $6198 +/- $1671 for group 1 versus $7469 +/- $2116 for group 2, p < 0.02. Total charges were $41 ,180 +/- $20,635 for group 1 versus $50,968 +/- $33,783 for group 2, w hich was not a significant difference. No difference was noted in morb idity, mortality, length of stay, or survival. Conclusions. Pancreatod uodenectomy in the elderly can be performed safely without accruing hi gher cost, increased morbity, or increased mortality.