The Influence of Resistant Flora on Costs and Their Structure During Pancreaticoduodenectomy

Aim. Analysis of the economic costs of treating patients undergoing pancreaticoduodenectomy (PDE), depending on the resistance of the microflora in the bile. Materials and methods. This retrospective study included patients over the age of 18 who underwent PDE at the Moscow Clinical Scientific Center named after A. S. Loginov from January 2019 to May 2023. The patients were divided into two groups: patients without resistant strains in bile (group 1) and patients with resistant microflora (group 2). Subsequently, an assessment of the course of the postoperative period was carried out: the frequency of surgical site infections, the duration of hospitalization, the cost of diagnosis and treatment, as well as drug provision. The statistical analysis of the data was carried out using the R 3.4.2 statistical package. Results. The cost of laboratory diagnostics amounted to 41,895 rubles in group 1 and 56,180 rubles in group 2 (P = 0.21); 13,000 rubles for instrumental diagnostics in group 1 and 23,500 rubles in group 2 (P = 0.084); 1,500 rubles for antibacterial therapy in group 1 and 18,000 rubles in group 2 (P = 0.39); 76,011 rubles for concomitant therapy in group 1 and 113,012 rubles in group 2 (P = 0.013). Cost analysis in the groups revealed a significant difference — 157,407 rubles in group 1 versus 282,276 rubles in the group of patients with resistant flora (P = 0.1). Conclusion. The presence of resistant flora in patients undergoing PDE significantly increases treatment costs. The main cost-increasing factors are the high rate of infectious complications, the need to use reserve antibiotics, prolonged hospitalization, and prolonged concomitant therapy. The results highlight the importance of optimizing perioperative antibiotic prophylaxis in order to reduce costs and improve treatment effectiveness.