Assessment of health care cost for complex surgical patients: Review of cost, re-imbursement and revenue involved in pancreatic surgery at a high-volume academic medical centre

Background Pancreatic surgery is complex with the potential for costly hospitalization. Methods A retrospective review of patients undergoing a pancreatic resection was performed. Results The median age of the study population was 64 years. Half of the cohort was female (51%), and the majority were white (62%). Most patients underwent a pancreaticoduodenectomy (PD) (69%). The pre-operative age-adjusted Charlson comorbidity index was zero for 36% (n = 50), 1 for 31% (n = 43) and ≥2 for 33% (n = 45). The Clavien-Dindo grading system for post-operative complication was grade I in 17% (n = 24), whereas 45% (n = 62) were higher grades. The medians direct fixed, direct variable, fixed indirect and total costs were 2476, 15 397, 13 207 and 31 631, respectively. There was a positive contribution margin of 7108, whereas the net margin was a loss of 6790. On univariate analyses, age, type of operation and complication grade were associated with total cost (P ≤ 0.05), whereas operation type and complication grade were associated with a net margin (P = 0.01). These findings remained significant on multivariate analysis (P < 0.05). Conclusions Increased cost, reimbursement and revenue were associated with type of operation and post-operative complications.