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Original Investigation |

Factors Associated With Interhospital Variability in Inpatient Costs of Liver and Pancreatic Resections

Howard Nelson-Williams, MD, MPH1; Faiz Gani, MBBS2; Arman Kilic, MD2; Gaya Spolverato, MD2; Yuhree Kim, MD, MPH2; Doris Wagner, MD2; Neda Amini, MD2; Aslam Ejaz, MD, MPH3; Timothy M. Pawlik, MD, MPH, PhD2
[+] Author Affiliations
1Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
2Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
3Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago
JAMA Surg. 2016;151(2):155-163. doi:10.1001/jamasurg.2015.3618.
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Importance  In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending.

Objective  To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in the United States.

Design, Setting, and Participants  Retrospective analysis of total costs among 42 480 patients undergoing hepatopancreaticobiliary surgery from January 1, 2002, through December 31, 2011, using a nationally representative data set (Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project). Analysis was conducted in May 2015.

Main Outcomes and Measures  Total inpatient costs and proportional variation in inpatient costs among individual hospitals.

Results  Among the 42 480 patients who underwent liver or pancreatic resection, the median age was 62 years, 52.4% were female, and 72.9% had a Charlson Comorbidity Index of 2 or higher. The median cost for the entire cohort was $21 535 (interquartile range, $15 373-$31 104), varying from $3320 to $279 102 among individual hospitals. On multivariable analysis, increasing patient comorbidity (coefficient, 2000.30; 95% CI, 1363.33-2637.27; P < .001) and operative characteristics (total pancreatectomy: coefficient, 12 742.31; 95% CI, 10 063.66-15 420.94; P < .001; lobectomy: coefficient, 6336.42; 95% CI, 3934.61-8737.24; P < .001) were associated with higher hospital costs. The development of postoperative complications, such as sepsis (coefficient, 30 571.25; 95% CI, 29 308.96-31 833.54; P < .001) or stroke (coefficient, 8925.34; 95% CI, 2801.38-15 049.30; P = .004), and a longer length of stay were most strongly predictive of higher inpatient cost (length of stay >14 days: coefficient, 44 162.24; 95% CI, 43 125.56-45 198.92; P < .001). After adjusting for patient and hospital characteristics, the overall cost of hepatopancreaticobiliary surgery varied by $9000 among individual hospitals.

Conclusions and Relevance  Significant variability was noted in hospital costs among patients undergoing pancreatic and liver surgery. Future policies should focus on reducing variations in costs by promoting payment paradigms that support a better quality of care and lower costs.

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Figure 1.
Total Hospital Costs for Liver and Pancreatic Resections Performed Between 2002 and 2011 by Individual Hospital
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Figure 2.
Forest Plot of Results of Multivariable Hierarchical Linear Regression Model Quantifying the Effects of Patient, Hospital, and Operative Characteristics on Total Hospital Costs for Patients Undergoing Liver or Pancreatic Surgery Between 2002-2011

Error bars indicate SD; LOS, length of stay.

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