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. 2021 Dec 14;13(24):6271.
doi: 10.3390/cancers13246271.

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

Ralph J A Linnemann  1 , Bob J L Kooijman  1 , Christian S van der Hilst  2 , Joost Sprakel  1 , Carlijn I Buis  1 , Schelto Kruijff  3 , Joost M Klaase  1
Affiliations

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

Ralph J A Linnemann et al. Cancers (Basel). .

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.

Keywords: PPPD; Whipple; complication; costs; pancreas; readmission.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Median hospital costs (no readmission vs. unplanned readmission sorted by CCI score).
Figure A2
Figure A2
Median hospital costs (no readmission vs. unplanned readmission sorted by Clavien–Dindo classification).
Figure 1
Figure 1
Cost analysis for Clavien-Dindo classification and CCI score. (A) Median total hospital costs (uncomplicated course and complicated course by Clavien–Dindo classification) (p = 0.001) (B) Median total hospital costs (complicated course by CCI score) (p = 0.001) (C) Correlation of CCI and log of total costs with Pearson correlation coefficient (rpears).
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