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PANCREATICODUODENECTOMY FOR PANCREATIC CANCER AT SPECIALIZED VERSUS COMMUNITY-BASED CARE FACILITIES: A VALUE-BASED ASSESSMENT
Muhammad Muntazir Mehdi Khan
*, Edward A. Joseph, Brandon Weiss, Philip E. Schumacher, Casey Allen
Surgical Oncology, Allegheny Health Network, Pittsburgh, PA
Background: Value-based care focuses on improving patient outcomes while reducing costs. High-risk procedures, such as pancreaticoduodenectomy (PD), are more commonly performed at specialized facilities. However, the value implications of care facility associated with this procedure remain understudied. We evaluate the outcomes and costs of patients who underwent PD for pancreatic cancer at specialized/academic versus community-based facilities.
Methods: Specific ICD-10 diagnosis and procedure codes were used to identify patients who underwent PD for malignant neoplasm of the pancreas from 2021 to 2023, using data from the Vizient® Clinical Data Base. Perioperative outcomes and costs were compared between Peer Group A (PGA) facilities, which include comprehensive academic medical centers, large specialized complex care centers, and the Alliance of Dedicated Cancer Centers, and Peer Group B (PGB) facilities, consisting of complex care medical centers, community hospitals, and critical access/small community hospitals.
Results: Among 5,729 patients, the mean age was 67.4±10.5 years; 48.5% (n=2,781) were female, and 78.2% (n=4,478) were White/Caucasian. Overall, the median length of stay (LOS) was 7.0 (IQR: 6.0 – 11.0) days, the complication rate was 8.7%, the 30-day readmission rate was 16.8%, and the in-hospital mortality rate was 1.6%. Of these patients, 95.0% (n=5,444) received care at PGA facilities. PGA patients were younger (67.3±10.5 vs 69.4±9.1, p<0.001) and more likely to be White (78.9% vs 63.9%, p<0.001). There were no differences in complication and readmission rates between groups. PGA facilities were associated with lower rates of extended LOS (21.6% vs 33.3%, p<0.001) and in-hospital mortality (1.5% vs 3.2%, p=0.027). Both direct ($35,452 [$27,451–$48,970] vs $41,463 [$30,530–$63,636], p<0.001) and total ($20,938 [$15,989–$29,221] vs $ 23,916 [$16,775–$35,673], p<0.001) costs were lower at PGA facilities. On multivariable analysis, there was no difference in in-hospital mortality (OR: 1.90, 95% CI: 0.94-3.86), complications (OR: 1.09, 95% CI: 0.73-1.63) and readmissions (OR: 1.13, 95% CI: 0.83-1.54) between the two cohorts (all p>0.050). PGB patients were more likely to be associated with extended LOS (OR: 1.68, 95% CI:1.30-2.17, p<001) as well as higher total (OR: 1.23, 95% CI: 1.13-1.35, p<0.001) and direct (OR: 1.21, 95% CI: 1.10-1.32, p<0.001) costs.
Conclusions: Cancer patients undergoing PD at academic/specialized care facilities experience improved outcomes and lower costs. These findings emphasize the benefit of performing a complex oncologic procedure at academic-based facilities but warrant the need for further investigation into other cancer surgeries.
Table: Demographic characteristics and peri-operative outcomes of patients undergoing pancreaticoduodenectomy for pancreatic cancer at peer group A and B facilities.
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