Hospital Volume and the Costs Associated with Surgery for Pancreatic Cancer

Faiz Gani, Fabian M. Johnston, Howard Nelson-Williams, Marcelo Cerullo, Mary E. Dillhoff, Carl R. Schmidt, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background: Data evaluating the financial implications of volume-based referral are lacking. This study sought to compare in-hospital costs for pancreatic surgery by annual hospital volume. Methods: Eleven thousand and eighty-one patients aged ≥18 years undergoing an elective pancreatic resection for cancer were identified using the Nationwide Inpatient Sample 2002–2011. Multivariable regression analysis was performed to compare length-of-stay (LOS), postoperative morbidity and mortality, failure-to-rescue (FTR), and inpatient costs by annual hospital volume group. Results: Patients undergoing surgery at high-volume hospitals (HVH) demonstrated 23% lower odds (odds ratio [OR] = 0.77, 95% confidence interval [95%CI] 0.63–0.95) of developing a postoperative complication, 59% lower odds of experiencing an LOS > 14 days (OR = 0.41, 95%CI 0.34–0.50), 51% lower odds of postoperative mortality (OR = 0.49, 95%CI 0.34–0.71), and 47% lower odds of FTR (OR = 0.53, 95%CI 0.37–0.76; all p<0.05). The overall mean in-hospital cost was $39,012 (SD = $15,214) with minimal differences observed across hospital volume groups. Rather, postoperative complications (no complication vs. complication $26,686 [SD = $5762] vs. $44,633 [SD = $11,637]) and FTR (rescue vs. FTR $42,413 [SD = $8481] vs. $69,546 [SD = $13,131]) were determinant of higher in-hospital costs. While this pattern was observed at all hospital volume groups, costs varied minimally between hospital volume groups after this stratification. Conclusions: Annual hospital surgical volume was not associated with in-hospital costs among patients undergoing pancreatic surgery.

Original languageEnglish (US)
Pages (from-to)1411-1419
Number of pages9
JournalJournal of Gastrointestinal Surgery
Issue number9
StatePublished - Sep 1 2017


  • Cost
  • Pancreas
  • Selective-referral
  • Volume-outcome

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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