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HPB (Oxford). 2017 Feb;19(2):140-146. doi: 10.1016/j.hpb.2016.10.016. Epub 2016 Nov 21.

Pancreas fistula risk prediction: implications for hospital costs and payments.

Author information

1
University of Wisconsin, USA. Electronic address: abbott@surgery.wisc.edu.
2
University of Texas MD Anderson Cancer Center, USA.
3
University of Pennsylvania, USA.
4
Beth Israel Deaconess Medical Center, USA.
5
University of Alabama-Birmingham, USA.
6
University of Tennessee, USA.
7
University of Cincinnati, USA.

Abstract

BACKGROUND:

As payment models evolve, disease-specific risk stratification may impact patient selection and financial outcomes. This study sought to determine whether a validated clinical risk score for post-operative pancreatic fistula (POPF) could predict hospital costs, payments, and profit margins.

METHODS:

A multi-institutional cohort of 1193 patients undergoing pancreaticoduodenectomy (PD) were matched to an independent hospital where cost, in US$, and payment data existed. An analytic model detailed POPF risk and post-operative sequelae, and their relationship with hospital cost and payment.

RESULTS:

Per-patient hospital cost for negligible-risk patients was $37,855. Low-, moderate-, and high- risk patients had incrementally higher hospital costs of $38,125 ($270; 0.7% above negligible-risk), $41,128 ($3273; +8.6%), and $41,983 ($3858; +10.9%), respectively. Similarly, hospital payment for negligible-risk patients was $42,685/patient, with incrementally higher payments for low-risk ($43,265; +1.4%), moderate-risk ($45,439; +6.5%) and high-risk ($46,564; +9.1%) patients. The lowest 30-day readmission rates - with highest net profit - were found for negligible/low-risk patients (10.5%/11.1%), respectively, compared with readmission rates of moderate/high-risk patients (15%/15.7%).

CONCLUSION:

Financial outcomes following PD can be predicted using the FRS. Such prediction may help hospitals and payers plan for resource allocation and payment matched to patient risk, while providing a benchmark for quality improvement initiatives.

PMID:
27884544
DOI:
10.1016/j.hpb.2016.10.016
[Indexed for MEDLINE]
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