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Implications and Cost of Pancreatic Leak Following Distal Pancreatic Resection
J. Rubén Rodríguez, MD;
Santos Soto Germes, MD;
Pari V. Pandharipande, MD;
G. Scott Gazelle, MD, MPH, PhD;
Sarah P. Thayer, MD, PhD;
Andrew L. Warshaw, MD;
Carlos Fernández-del Castillo, MD
Arch Surg. 2006;141:361-366.
Objectives Pancreatic stump leak (PL) after elective distal pancreatic resection significantly impacts cost and increases subsequent health care resource utilization. We sought to provide an economic framework for potential interventions aimed at reducing its occurrence.
Design Retrospective case series and economic evaluation.
Setting University-affiliated, tertiary care referral center.
Patients Sixty-six patients undergoing elective distal pancreatectomy.
Main Outcome Measures Postoperative complications; hospital and professional costs.
Results Overall postoperative morbidity occurred in 34 patients (52%) with no deaths. The total number of patients with complications directly related to PL was 22 (33%). The mean ± SD number of total hospital days for the no-PL group was 5.2 ± 1.7 days (range, 3-12 days) vs 16.6 ± 14.6 days (range, 4-49 days) for the PL group (P = .001). The average patient with PL-related problems incurred a total cost that was 2.01 times greater than the average patient in the no-PL group. A decision analytic model developed to evaluate threshold costs showed that a hypothetical intervention designed to reduce the complication rate of distal pancreatectomy by one third would be financially justifiable up to a cost of $1418 per patient.
Conclusions Complications derived from PL following distal pancreatectomy double the cost and dramatically increase health care resource utilization. There is an urgent need to develop strategies that reduce the incidence of this common complication. Interventions aimed at decreasing the incidence of PL should take into account this cost differential. We provide an economic model to serve as a guide for developing these technologies.
Author Affiliations: Center for Clinical Effectiveness in Surgery (Drs Rodríguez, Germes, Thayer, Warshaw, and Fernández-del Castillo) and Institute for Technology Assessment, Massachusetts General Hospital (Drs Pandharipande and Gazelle), Harvard Medical School, Boston.
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