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PREDICTING THE COST OF WHIPPLE SURGERY USING PREOPERATIVE PATIENT CHARACTERISTICS AND RISK PROFILES
Sri Snehita Reddy Bonthu
*1, Sourodip Mukharjee
2, Joshua Kong
2, Joseph Buell
2, juan malo
2, Houssam Osman
2, D Rohan Jeyarajah
2,11Texas Christian University Anne Burnett Marion School of Medicine, Fort Worth, TX; 2Methodist Richardson Medical Center, Richardson, TX
Background. Pancreatic surgeries, especially Whipple’s pancreaticoduodenectomy (PD), are complex operations associated with high morbidity and mortality and, consequently, considerable healthcare costs. Modifiable lifestyle-related factors like smoking and higher body mass index (BMI) commonly contribute to increased healthcare expenses. However, additional factors, such as gender, age, functional capacity, presence of concurrent illnesses, and the American Society of Anesthesiologists (ASA) physical status, have emerged as predictors of postoperative complications, which indirectly influence care costs driven by medical consults, labs and imaging, ward, medications, intensive care, and allied health services. This study aims to examine the association between risk factors and higher costs of undergoing Whipple’s PD.
Methods. A retrospective review was conducted of all patients who underwent Whipple surgeries for pancreatic cancer at a high-volume tertiary care center between 2018 and 2023. Patient demographics, including age and sex, and clinical risk factors such as BMI, smoking history, presence of comorbidities such as diabetes and hypertension, preoperative lab values, and ASA status were collected. The total charges for the admission for index surgery were determined for each patient, and the correlation between risk factors and economic costs was evaluated.
Results. A total of 375 cases were analyzed. On univariate logistic regression, preoperative labs, including white blood count (p=0.031), hemoglobin (p<0.001), hematocrit (p<0.001), prothrombin time (p=0.004), international normalized ratio (p<0.001), albumin (p<0.001) and hemoglobin A1c (p=0.013) were found to be significant predictors of total charges of initial hospital admission and stay. Interestingly, these charges were also significantly influenced by the primary insurance payor (p=0.018) and future disposition of patients (p<0.001), with costs notably lower in patients discharged directly to home rather than to rehabilitation centers.
Conclusion. Various preoperative factors were identified as contributing to increased surgical costs, some of which are modifiable. These results can further help estimate the cost of Whipple procedures better and optimize the preoperative management of modifiable risk factors for patients undergoing PD to reduce patient and hospital burden.
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