The Costs of Complications and Unplanned Readmissions after Pancreatoduodenectomy for Pancreatic and Periampullary Tumors: Results from a Single Academic Center

Abstract

Background/Objectives: Complications after pancreatoduodenectomy (PD) lead to unplanned readmissions (UR), with a two- to threefold increase in admission costs. In this study, we aimed to create an understanding of the costs of complications and UR in this patient group. Furthermore, we aimed to generate a detailed cost overview that can be used to build a theoretical model to calculate the cost efficacy for prehabilitation. Methods: A retrospective cohort analysis was performed using the Dutch Pancreatic Cancer Audit (DPCA) database of patients who underwent a PD at our institute between 2013 and 2017. The total costs of the index hospital admission and UR related to the PD were collected. Results: Of the 160 patients; 35 patients (22%) had an uncomplicated course; 87 patients (54%) had minor complications, and 38 patients (24%) had severe complications. Median costs for an uncomplicated course were EUR 25.682, and for a complicated course, EUR 32.958 (p = 0.001). The median costs for minor complications were EUR 30.316, and for major complications, EUR 42.664 (p = 0.001). Costs were related to the Comprehensive Complication Index (CCI). The median costs of patients with one or more UR were EUR 41.199. Conclusions: Complications after PD led to a EUR 4.634–EUR 16.982 (18–66%) increase in hospital costs. A UR led to a cost increase of EUR 12.567 (44%). Since hospital costs are directly related to the CCI, reduction in complications will lead to cost-effectiveness.

Preoperative C-Reactive Protein-to-Albumin Ratio Predicts Postoperative Pancreatic Fistula following Pancreatoduodenectomy: A Single-Center, Retrospective Study

“…The rate of POC following PD remains high despite advanced surgical skills and perioperative management [ 1 ]. In addition, the mortality rate of PD ranges from 1.7% to 4.2% [ 17 , 18 ].…”

“…Rijssen et al [ 3 ] showed that POPF was mainly attributable to worse mortality. Moreover, Linnemann et al [ 1 ] showed that medical costs increased by about 50% after POCs following PD. Thus, adequate prevention or treatment of POPF can contribute to reducing the mortality rate.…”

“…Pancreatoduodenectomy (PD) is the standard surgical procedure for treating periampullary tumors. Although surgical techniques and perioperative management have drastically improved, PD-related postoperative complication (POC) rates still reach up to 54% [ 1 ]. Among the potential POCs, the most potentially fatal POC is postoperative pancreatic fistula (POPF).…”

Prehabilitation: tertiary prevention matters

“…Redirecting this funding towards prehabilitation interventions at the outset could substantially enhance surgical outcomes. Notably, a correlation exists between total hospital admission costs and the comprehensive complication index 5 . This emphasizes that not only the most severe but every additional complication has impact.…”

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

“…Another important argument to estimate the post-operative risk is to reduce the adverse consequences of the complications. It is known that complications can lead to multiple organ failure or mortality, prolong hospital stay and/or required readmission and increased costs [ 24 , 25 , 26 ]. A complicated course after pancreatoduodenectomy may lead to impaired long-term survival [ 27 ].…”