Background: Morbidity and costs after pancreatoduodenectomy remain increased, driven by postoperative pancreatic fistula (POPF). A risk-based pathway for pancreatoduodenectomy (RBP-PD) was implemented and the clinical and cost outcomes compared with that of our historic practice. Methods: Prospective clinical and cost outcomes for our RBP-PD cohort treated from September 2014 to September 2015 were compared with a previously published cohort of pancreatoduodenectomies from January 2007 to February 2014. Results: A total of 128 RBP-PD cases were compared with 808 historic controls. Apart from less blood loss, there were no significant clinical differences between the 2 groups. Overall POPF rate did not change. Average duration of stay decreased to 10 days from 12 (P <.001) despite similar readmission rates. Postsurgical interventional radiology procedures decreased to 18.0% from 26.4% (P =.048). Utilization of and duration of stay in monitored care decreased to 23.4% from 35.6% (P <.01) and to 1 day from 3 (P <.01). On multivariable analysis RBP-PD was independently associated with decreased odds of higher postoperative pancreatic fistula grade, monitored care, and prolonged duration of stay. Inpatient cost of care decreased $6,387 per patient (–11.1%, P =.016), and total 30-day costs decreased $8,565 per patient (–13.7%, P =.01), representing a total 30-day cost savings of $1.1 million. Conclusion: RBP-PD significantly improved patient outcomes, decreased costs of care, and likely has applicability for surgical care beyond pancreatoduodenectomy.
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