Table 5. Multivariable Models for Overall Survival, Surgical Hospitalization Costs, and High Value.
| Variable | Survivala | Costsb | High Valuec | |||
|---|---|---|---|---|---|---|
| aHR (95% CI) | P Value | Estimate (95% CI) | P Value | aOR (95% CI) | P Value | |
| Age | 1.01 (1.01 to 1.02) | <.001 | 0.000 (−0.001 to 0.001) | .90 | 0.99 (0.98 to 1.00) | .06 |
| Sex | ||||||
| Male | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| Female | 0.91 (0.83 to 0.99) | .02 | −0.02 (−0.04 to 0.01) | .17 | 1.10 (1.01 to 1.19) | .048 |
| Race | ||||||
| White | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| Asian/Pacific Islander | 1.01 (0.88 to 1.16) | .88 | −0.04 (−0.10 to 0.01) | .10 | 0.92 (0.42 to 1.41) | .73 |
| Black | 1.08 (0.90 to 1.31) | .40 | 0.02 (−0.04 to 0.09) | .44 | 1.02 (0.48 to 1.56) | .94 |
| Other/unknown | 0.84 (0.44 to 1.58) | .58 | −0.10 (−0.29 to 0.10) | .34 | 1.11 (0.00 to 2.36) | .87 |
| Socioeconomic status | ||||||
| Low | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| Low to middle | 1.01 (0.88 to 1.15) | .90 | −0.01 (−0.05 to 0.03) | .69 | 0.87 (0.65 to 1.09) | .22 |
| Middle | 0.95 (0.83 to 1.09) | .46 | −0.01 (−0.05 to 0.03) | .62 | 0.94 (0.77 to 1.11) | .47 |
| Middle to high | 0.92 (0.80 to 1.05) | .22 | 0.02 (−0.03 to 0.07) | .39 | 1.13 (0.90 to 1.36) | .30 |
| High | 0.89 (0.77 to 1.02) | .08 | −0.02 (−0.08 to 0.03) | .39 | 1.25 (1.06 to 1.44) | .02 |
| Elixhauser comorbidity index | 1.01 (1.01 to 1.02) | <.001 | 0.006 (0.003 to 0.008) | <.001 | 0.97 (0.95 to 0.98) | <.001 |
| Grade | ||||||
| Well differentiated | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| Moderately differentiated | 1.49 (1.28 to 1.73) | <.001 | −0.03 (−0.09 to 0.03) | .40 | 1.06 (0.89 to 1.23) | .49 |
| Poorly differentiated or undifferentiated | 1.84 (1.57 to 2.16) | <.001 | −0.03 (−0.10 to 0.05) | .46 | 0.65 (0.39 to 0.91) | .001 |
| T category | ||||||
| T1 | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| T2 | 1.26 (1.03 to 1.55) | .03 | 0.01 (−0.06 to 0.08) | .40 | 1.20 (0.99 to 1.41) | .10 |
| T3 | 1.45 (1.16 to 1.80) | <.001 | 0.05 (−0.04 to 0.15) | .27 | 0.71 (0.46 to 0.95) | .005 |
| N category | ||||||
| N0 | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| N1 | 1.47 (1.32 to 1.63) | <.001 | 0.00 (−0.04 to 0.03) | .86 | 0.70 (0.00 to 1.42) | .33 |
| AJCC stage | ||||||
| I | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| II | 1.27 (1.02 to 1.57) | .03 | 0.03 (−0.05 to 0.11) | .42 | 0.87 (0.64 to 1.09) | .21 |
| Pancreatic resection | ||||||
| Pancreaticoduodenectomy | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| Distal pancreatectomy | 1.03 (0.91 to 1.18) | .61 | −0.21 (−0.26 to −0.17) | <.001 | 1.31 (0.95 to 1.67) | .14 |
| Other pancreatectomy | 0.93 (0.73 to 1.18) | .55 | −0.13 (−0.23 to −0.02) | .02 | 1.72 (1.29 to 2.14) | .01 |
| Total pancreatectomy | 1.47 (1.18 to 1.82) | <.001 | 0.05 (−0.04 to 0.15) | .26 | 0.40 (0.00 to 1.06) | .007 |
| Chemotherapy | ||||||
| None | 1 [Reference] | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| Postoperative | 0.71 (0.64 to 0.79) | <.001 | −0.06 (−0.11 to −0.02) | .006 | 1.22 (1.02 to 1.43) | .05 |
| Preoperative | 0.78 (0.61 to 1.01) | .06 | 0.07 (−0.01 to 0.15) | .10 | 0.85 (0.55 to 1.15) | .28 |
| Radiotherapy | 0.96 (0.87 to 1.06) | .40 | 0.00 (−0.04 to 0.04) | .90 | 0.89 (0.77 to 1.00) | .05 |
| NCI-designated cancer center | 1.02 (0.82 to 1.28) | .84 | −0.03 (−0.24 to 0.19) | .80 | 1.07 (0.66 to 1.49) | .74 |
| Teaching hospital | 1.06 (0.88 to 1.29) | .55 | 0.08 (−0.10 to 0.26) | .38 | 0.84 (0.33 to 1.35) | .49 |
| High-volume centerd (≥20) | 0.78 (0.61 to 0.99) | .04 | 0.11 (−0.09 to 0.32) | .28 | 1.08 (0.54 to 1.61) | .07 |
| Complication within 30 d | 1.18 (1.07 to 1.30) | .001 | 0.22 (0.17 to 0.27) | <.001 | 0.68 (0.49 to 0.86) | <.001 |
| Readmission within 30 d | 1.01 (0.90 to 1.12) | .93 | 0.34 (0.29 to 0.39) | <.001 | 0.64 (0.44 to 0.84) | <.001 |
| Length of stay | 1.00 (1.00 to 1.00) | .94 | 0.03 (0.03 to 0.04) | <.001 | 0.82 (0.78 to 0.85) | <.001 |
Abbreviations: aHR, adjusted hazard ratio; AJCC, American Joint Committee on Cancer, seventh edition; aOR, adjusted odds ratio; NA, not applicable; NCI, National Cancer Institute.
a
Based on Cox proportional hazards model, adjusted for within-hospital clustering of patients.
b
Includes the index surgical hospitalization and readmissions within 30 days. Cost estimates based on generalized linear model with gamma distribution and log link, adjusted for within-hospital clustering of patients.
c
Defined as the fourth quintile for survival (≥26 months) and second quintile or less for costs (≤$40 674). Odds ratios based on logistic regression model, adjusted for within-hospital clustering of patients.
d
Indicates 20 or more cases annually.