BACKGROUND : There is significant variation in inpatient expenditures among physicians and hospitals. We sought to characterize the association of variation in physician spending with short-term outcomes among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC) and colorectal cancer (CRC).

METHODS : Patients who underwent surgery for PDAC and CRC from 2010-2020 were identified using the Surveillance, Epidemiology, and End Result (SEER)-Medicare-linked database. The cohort was divided into quartiles based on adjusted physician spending and multivariable models were utilized to assess the association of physician spending with patient outcomes.

RESULTS : Among 27,596 Medicare beneficiaries, around 92.8% (n=25,615) and 7.2% (n=1,981) underwent surgery for CRC and PDAC, respectively. Around 79.9% of the variation in spending was due to patient-level factors, 13.3% was due to hospital characteristics, and 6.8% was due to surgeon-level variables. On multivariable analysis, there was no significant association between physician spending and 30-day readmission (With complications: Q1 referent; Q4 OR 1.10 95%CI 0.86-1.41 [p=0.123], Without complications: Q1 referent; Q3 Stage IV OR 0.97 95%CI 0.68-1.40 [p=0.882]) and 30-day mortality (Without Complications: Q1 referent; Q2 Stage I OR1.17 95% CI 0.45-3.01 [p=0.804]). However, an increase in physician spending was associated with higher 30-day mortality among patients with complications (Q1 referent; Q4 OR 2.28 95%CI 1.72-3.03[p<0.001]).

CONCLUSION : There is more variation in healthcare spending across hospitals than across individual physicians. Our results demonstrated no consistent association between variation in physician spending and patient outcomes. Wasteful spending can be reduced through targeted interventions aimed at reducing variations at the physician and hospital levels.