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Regional Hospital Charges for Pancreaticoduodenectomy in Florida: Location Matters
Sharona B. Ross*, Amanda E. Smart, Carrie E. Ryan, Thomas W. Wood, Prashant Sukharamwala, Alexander S. Rosemurgy
Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, Tampa, FL
Introduction: Concentration of care with regionalization of care for any operation raises potential for regional differences in cost of care and outcome. This study was undertaken to determine if charges and outcome after pancreaticoduodenectomy vary by region in Florida, and if so, are charges and outcome related?
Methods: Inpatient data for pancreaticoduodenectomy in Florida during 2010-2012 were obtained from the Florida Agency for Health Care Administration. Seven geographically different regions were designated based on cost of living index and urban to rural population ratio. Hospital charges (adjusted to 2012 dollars), length of stay, in-hospital mortality, and the frequency with which surgeons undertook pancreaticoduodenectomy were evaluated for these regions.
Results: The median hospital charges for pancreaticoduodenectomy from region to region ranged from $101,436 to $214,971 (Figure). Median hospital charges by the regions correlated positively with LOS (p<0.0001) and in-hospital mortality (p<0.03) and negatively with the more frequently with which pancreaticoduodenectomy was undertaken in the regions (r=0.43; p<0.0001). Among the regions, the lower the median hospital charges, the more high-volume surgeons were undertaking pancreaticoduodenectomy (p<0.001).
Conclusions: There are tremendous regional differences for hospital charges with pancreaticoduodenectomy in Florida, with one region charging over double that of another. The regions with lower median charges had more high-volume surgeons, shorter hospital stays, and lower in-hospital mortality rates. Regional differences in cost and quality of care need to be studied and abrogated to provide uniform optimal care.
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