Variability in postoperative resource utilization after pancreaticoduodenectomy: Who is responsible

Background We aimed to quantify and predict variability that exists in resource utilization after pancreaticoduodenectomy and determine how such variability impacts postoperative outcomes. Methods The University HealthSystems Consortium database was queried for all pancreaticoduodenectomies performe...

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Bibliographic Details
Published in:Surgery 2016-12, Vol.160 (6), p.1477-1484
Main Authors: Ertel, Audrey E., MD, MS, Wima, Koffi, MS, Hoehn, Richard S., MD, Chang, Alex L., MD, Hohmann, Samuel F., PhD, Ahmad, Syed A., MD, FACS, Sussman, Jeffrey J., MD, FACS, Shah, Shimul A., MD, MHCM, FACS, Abbott, Daniel E., MD, FACS
Format: Article
Language:English
Subjects:
Aged
Female
Health Resources - utilization
Hospital Mortality
Hospitalization
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Male
Middle Aged
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Postoperative Care - utilization
Surgery
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Summary:Background We aimed to quantify and predict variability that exists in resource utilization after pancreaticoduodenectomy and determine how such variability impacts postoperative outcomes. Methods The University HealthSystems Consortium database was queried for all pancreaticoduodenectomies performed between 2011–2013 ( n  = 9,737). A composite resource utilization score was created using z-scores of 8 clinically significant postoperative care delivery variables including number of laboratory tests, imaging tests, computed tomographic scans, days on antibiotics, anticoagulation, antiemetics, promotility agents, and total number of blood products transfused per patient. Logistic, Poisson, and gamma regression models were used to determine predictors of increased variability in care between patients. Results Having a high (versus low) resource utilization score after pancreaticoduodenectomy correlated with increased duration of stay; (odds ratio 2.28), cost (odds ratio 1.89), readmission rate (odds ratio 1.46), and mortality (odds ratio 7.54). Patient-specific factors were the strongest predictors and included extreme severity of illness (odds ratio 114), major comorbidities/complications (odds ratio 5.99), and admission prior to procedure (odds ratio 2.72; all P  
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2016.08.031