Variation in the cost-of-rescue among medicare patients with complications following hepatopancreatic surgery

Abstract

Background: The relationship of expenditures related to rescuing patients from complications and hospital quality has not been well characterized. We sought to examine the relationship between payments for treating post-operative complications after liver and pancreas surgery and hospital quality. Methods: A retrospective cohort study of patients who underwent hepatopancreatic surgery was performed using claims data from 2013 to 2015 in the Medicare Provider Analysis and Review (MEDPAR) database. Medicare payments for index hospitalization and readmissions, as well as perioperative clinical outcomes were analyzed. Hospitals were stratified using average payments for patients who were rescued from complications (cost-of-rescue). Results: A total of 13,873 patients and 737 hospitals were included in the analyses. Patient characteristics were similar across hospitals. Risk-adjusted rates of overall complications were higher at the highest cost-of-rescue hospitals (relative risk [

Novel Machine Learning Approach to Identify Preoperative Risk Factors Associated With Super-Utilization of Medicare Expenditure Following Surgery

“…Typically, only costs of care based on the time around the surgical episode itself (eg, 30-day perioperative period) have been examined. 1,2,5,[13][14][15][16][17][18][19][20]22,23,40 Although previous studies have identified super-utilizers at the time of surgical intervention, data on the longer-term relationship of these patients with the health care system have not been well examined. To our knowledge, no study has longitudinally analyzed superutilization following surgical intervention.…”

“…Data on super-utilizers in the surgical population have been limited because only a few studies have investigated characteristics associated with increased expenditure at the time of the surgical episode. 1,2,[13][14][15][16][17][18][19]23,24 In addition, the assessment of overall expenditure has varied among different studies. For example, some investigators have considered expenditure as a continuous measure, aiming to identify factors associated with a higher "average" expenditure.…”

“…For example, some investigators have considered expenditure as a continuous measure, aiming to identify factors associated with a higher "average" expenditure. 2,[14][15][16][17][18][19]23,24 By contrast, other authors have focused more on factors associated with being in the high-expenditure group rather than on comparing average expenditure. 1,4,13 In the present study, we specifically sought to identify factors associated with increased overall expenditure in the 12 months following surgical intervention.…”

“…1,12,13 Previous studies have identified episode-level characteristics associated with increased expenditure at the time of surgery, including patient age, comorbidities at the time of surgery, surgical approach, and perioperative and postoperative complications. 1,3,9,[14][15][16][17][18][19] Other studies have identified hospital-level characteristics associated with expenditure variability, such as hospital volume, affordable care organization status, hospital network participation, and the use of bundled payments. 2,5,15,[20][21][22][23][24] These studies, however, have largely considered health care expenditure only during the perioperative period.…”

Insurance Coverage Type Impacts Hospitalization Patterns Among Patients with Hepatopancreatic Malignancies

“…[13] Patients undergoing hepatopancreatic (HP) procedures for a malignant indication are at a particular risk for variable outcomes relative to patient-, surgeon-, and hospital-factors. [14][15][16][17][18] In particular, HP surgery may be associated with high morbidity, as well as variable rates of failure-to-rescue, and health care expenditures depending on the surgeon and hospital. [19][20][21][22] As such, disparities in access to high-quality, high-volume surgical care can dramatically impact patient outcomes.…”