Financial impact of postoperative complication following hepato-pancreatico-biliary surgery for cancer

Background: Despite increasing efforts for cost containment, little is known regarding the financial implications of postoperative complication under current volume-driven payment paradigms. This study sought the test the associations between hospital finances and postoperative complications among hepato-pancreatico-bilary cancer patients. Methods: Patients undergoing surgery for the management of a hepatobiliary or pancreatic cancer between January 1, 2009 and December 31, 2013 were identified using institutional claims and cost-accounting data. Multivariable linear regression analyses were used to calculate risk-adjusted fixed and variable costs, payments, and net margins. Results: A total of 1483 met inclusion criteria. Fixed ($9290 [interquartile range (IQR)$7129-$11,598] vs.$14,784 [IQR $10,523-$22,799], p \u3c 0.001) and variable costs ($12,342 [IQR$9886-$14,762] vs.$19,330 [IQR $13,967-$29,435], p \u3c 0.001) were higher among patients who developed a postoperative complication following a hepatectomy. A higher contribution margin ($12,421 [IQR$8440-$16,445] vs.$20,016 [IQR $14,212-$39,179], p \u3c 0.001), as well as a twofold higher net profit was noted among patients who developed postoperative complication ($2788 [IQR$660-$5815] vs.$5515 [IQR $1068-$10,315], p \u3c 0.001). Total hospital costs ($26,840 [IQR$21,318-$35,358] vs.$46,628 [IQR $31,974-$69,326], p \u3c 0.001) as well as payments ($32,761 [IQR$26,394-$41,883] vs.$53,612 [IQR $38,548-$78,116], p \u3c 0.001) were more than 1.5 times higher among patients who developed a postoperative complication following pancreatic resection. Contribution margins ($18,356 [IQR$14,024-$24,390] vs.$29,153 [IQR $20,256-$41,785], p \u3c 0.001), as well as net profits ($5907 [IQR$2179-$9412] vs.$8114 [IQR $2518-$14,249], p \u3c 0.001) were higher among patients who developed postoperative complication following pancreatic surgery. Conclusions: A positive association was observed between net profits and postoperative complications. Future policies should target complications as a means to achieving a higher value for car

Geophysics Field Camp 2011

Transient Electromagnetic (TEM), Controlled Source Audio Magnetotellurics (CSAMT), Gravity, and Magnetic data were collected in the Tucson Mountains during the Spring semester, 2011. The goal was to investigate the extent of a low-resistivity porous sedimentary layer and faults that may form potential traps located under the surface volcanic layers, as interpreted by Lipman 1993. The sedimentary layer under the volcanics has the potential to be used for either water resources or compressed air storage to store solar energy. The results from the TEM and CSAMT surveys broadly correlated with the thickness of the volcanic layer and throw of the faults interpreted by Lipman, 1993. The gravity modeling suggested the faults may have a larger throw than what was indicated by the other methods. Because of the fundamental uncertainty in the densities to use in the modeling, it was concluded that the gravity modeling may not give as accurate a prediction of the structure in this region. For further investigation of the deep porous sedimentary layer, we suggest that TEM and CSAMT are the most effective methods.The Geophysics Field Camp Reports are made available by the Laboratory for Advanced Subsurface Imaging (LASI) and the University of Arizona Libraries. Visit the LASI website for more information http://www.lasi.arizona.edu