The cost of perioperative complications following pancreaticoduodenectomy: A systematic review

Abstract

Background/objectives: Pancreaticoduodenectomy (PD), also known as a Whipple procedure, is commonly performed for a variety of benign and malignant tumours, including of the pancreatic head and surrounding structures. PD is associated with low mortality but high morbidity and costs. Our objective was to describe the financial burden of complications following pancreaticoduodenectomy.

Methods: We searched for articles using the MEDLINE, EMBASE, Cochrane and EconLit databases from the year 2000. Additional studies were identified by searching bibliographies. We included studies reporting on hospital cost or charge of in-hospital complications during the index PD admission. Studies including other surgeries but specifically reporting inpatient complication costs of PD were also included. Any type of PD was included. Data was collected using a data extraction table and a narrative synthesis was performed.

Results: We identified 15 eligible articles. All included articles were retrospective studies. Acceptable evidence for increased cost due to the presence and grade of complication was found. Strong evidence demonstrated the high rate of complications. Weak evidence linked complications with specific constituents of hospital cost. Complication grade was robustly linked with increased length of stay. Not enough evidence was found to demonstrate a link between PD complications and mortality or readmissions.

Limitations: Included studies were heterogeneous in setting, methodology, costing data, and grading systems.

Conclusions: The presence and grade of PD complications increase hospital cost across diverse settings. The costing methodology should be transparent and complication grading systems should be consistent in future studies.

Systematic review registration number: PROSPERO 2017:CRD42017058427.

Keywords: Costs and cost analysis; Hospital costs; Pancreas; Pancreaticoduodenectomy; Postoperative complications.