胰十二指肠切除术是一种高发病率且资源利用率高的手术。我们利用全国队列研究了美国胰十二指肠切除术住院费用的医院间差异。在胰腺癌背景下接受选择性胰十二指肠切除术的成人的数据来自 2016-2020 年全国再入院数据库。开发了一个二级混合效应模型来评估胰十二指肠切除术住院费用的医院间差异。风险调整支出前十分之一的机构被定义为高成本医院。拟合多变量回归模型来检查高成本医院状况与感兴趣的结果之间的关联。为了考虑并发症对支出的影响，我们对没有发生不良事件的患者进行了亚组分析。该研究包括估计 24,779 名患者，平均住院费用为 38,800 美元。混合效应建模后，40.9% 的成本变化归因于医院因素，而不是患者因素。多变量回归模型揭示了高费用住院状态与更大的并发症发生率和更长的住院时间之间的关联。在没有不良事件的患者中，医院间费用差异仍然很大，为 61.0%，并且在高费用医院的治疗同样与较长的住院时间相关。我们的研究发现，美国胰十二指肠切除术住院费用存在显着的医院间差异。尽管高费用住院状况与并发症发生几率增加相关，但即使在没有不良事件的患者中，差异仍然很大。这些结果表明医院实践作为支出贡献者的重要作用。有必要进一步努力确定成本驱动因素并使胰腺手术护理标准化。版权所有 © 2024 作者。由爱思唯尔公司出版。保留所有权利。

Pancreaticoduodenectomy is a highly morbid operation with significant resource utilization. Using a national cohort, we examined the interhospital variation in pancreaticoduodenectomy hospitalization cost in the United States.Adults undergoing elective pancreaticoduodenectomy in the setting of pancreatic cancer were tabulated from the 2016-2020 Nationwide Readmissions Database. A 2-level mixed-effects model was developed to evaluate the interhospital variation in pancreaticoduodenectomy hospitalization costs. Institutions within the top decile of risk-adjusted expenditures were defined as high-cost hospitals. Multivariable regression models were fitted to examine the association between high-cost hospital status and outcomes of interest. To account for the effects of complications on expenditures, a subgroup analysis comprising of patients with no adverse events was conducted.The study included an estimated 24,779 patients with a median hospitalization cost of $38,800. After mixed-effects modeling, 40.9% of the cost variation was attributable to hospital, rather than patient, factors. Multivariable regression models revealed an association between high-cost hospital status and greater odds of complications and longer length of stay. Among patients without an adverse event, interhospital cost variation remained significant at 61.0%, and treatment at high-cost hospitals was similarly linked to longer length of stay.Our study identified significant interhospital variation in pancreaticoduodenectomy hospitalization costs in the United States. Although high-cost hospital status was associated with increased odds of complications, variation remained significant even among patients without an adverse event. These results suggest the important role of hospital practices as contributors to expenditures. Further efforts to identify drivers of costs and standardize pancreatic surgical care are warranted.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.