Factors associated with interhospital variability in inpatient costs of liver and pancreatic resections

Abstract

IMPORTANCE In an era of accountable care, understanding variation in health care costs is critical to reducing health care spending. OBJECTIVE To identify factors associated with increased hospital costs and quantify variations in costs among individual hospitals in patients undergoing liver and pancreatic surgery in the United States. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of total costs among 42 480 patients undergoing hepatopancreaticobiliary surgery from January 1, 2002, through December 31, 2011, using a nationally representative data set (Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project). Analysis was conducted in May 2015. MAIN OUTCOMES AND MEASURES Total inpatient costs and proportional variation in inpatient costs among individual hospitals. RESULTS Among the 42 480 patients who underwent liver or pancreatic resection, the median age was 62 years, 52.4%were female, and 72.9% had a Charlson Comorbidity Index of 2 or higher. The median cost for the entire cohort was $21 535 (interquartile range, $15 373-$31 104), varying from $3320 to $279 102 among individual hospitals. On multivariable analysis, increasing patient comorbidity (coefficient, 2000.30; 95%CI, 1363.33-2637.27; P 14 days: coefficient, 44 162.24; 95%CI, 43 125.56-45 198.92; P