Implications and cost of pancreatic leak following distal pancreatic resection

Abstract

Objectives: Pancreatic stump leak (PL) after elective distal pancreatic resection significantly impacts cost and increases subsequent health care resource utilization. We sought to provide an economic framework for potential interventions aimed at reducing its occurrence.

Design: Retrospective case series and economic evaluation.

Setting: University-affiliated, tertiary care referral center.

Patients: Sixty-six patients undergoing elective distal pancreatectomy.

Main outcome measures: Postoperative complications; hospital and professional costs.

Results: Overall postoperative morbidity occurred in 34 patients (52%) with no deaths. The total number of patients with complications directly related to PL was 22 (33%). The mean +/- SD number of total hospital days for the no-PL group was 5.2 +/- 1.7 days (range, 3-12 days) vs 16.6 +/- 14.6 days (range, 4-49 days) for the PL group (P = .001). The average patient with PL-related problems incurred a total cost that was 2.01 times greater than the average patient in the no-PL group. A decision analytic model developed to evaluate threshold costs showed that a hypothetical intervention designed to reduce the complication rate of distal pancreatectomy by one third would be financially justifiable up to a cost of $1418 per patient.

Conclusions: Complications derived from PL following distal pancreatectomy double the cost and dramatically increase health care resource utilization. There is an urgent need to develop strategies that reduce the incidence of this common complication. Interventions aimed at decreasing the incidence of PL should take into account this cost differential. We provide an economic model to serve as a guide for developing these technologies.

Figure 1

Distribution of pancreatic stump leak complications in 22 patients following distal pancreatectomy.

Figure 2

Health care resource utilization following distal pancreatectomy in 44 patients without and 22 with pancreatic stump leak (PL). All comparisons were significant (P<.001). A, Mean number of emergency department visits and hospital readmissions. B, Mean number of postoperative computed tomographic (CT) scans and office visits. C, Mean total number of hospital days and duration of follow-up.

Figure 3

Threshold cost of hypothetical distal pancreatectomy intervention as a function of the reduction in the proportion of patients with a pancreatic stump leak (PL).