R. H. Hollis1, L. N. Wood1, M. S. Morris1, D. I. Chu1, J. S. Richman1, M. Kilgore3, M. T. Hawn2 1University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA 2Stanford University,Surgery,Palo Alto, CA, USA 3University Of Alabama at Birmingham,Health Care Organization And Policy,Birmingham, Alabama, USA
Introduction:
Improvements in colon surgery, including the adoption of laparoscopy, are associated with reduced complications and length of stay. Whether this has translated into reduced inpatient costs over time is unclear.
Methods:
We identified patients undergoing colectomy procedures with a diagnosis of colon cancer over years 2002-2011 in the Nationwide Inpatient Sample. Inpatient costs in 2011 dollars were estimated using hospital charges and cost-to charge ratios. Secondary outcomes included rates of laparoscopy, length of stay, and inpatient complications. A log-level model was used to evaluate the association between inpatient costs and year of surgery adjusting for patient, procedure, and hospital characteristics. A separate model additionally controlling for laparoscopy, length of stay, and inpatient complications was used to evaluate the effect of these important cost mediators on temporal trends in costs.
Results:
Among 437,607 colectomies performed for cancer over one decade, the median cost for the inpatient hospitalization was $14,703 (IQR 10,779-$21,132). From 2002 to 2011, laparoscopy use increased from 2.1% to 45.7%, and median length of stay decreased from 6 days to 5 days. The odds of any inpatient complication in 2011 was significantly lower compared to 2002 (OR 0.79, 95%CI 0.70-0.89). After controlling for patient, procedure, and hospital characteristics, the costs of surgery in 2011 were not significantly different from costs in 2002 (0.7 percentage point increase, 95%CI: -1.5-3.0) (figure). When controlling for changes in laparoscopy, length of stay, and inpatient complication rates, inpatient costs were significantly higher in 2011 compared to 2002 (3.4 percentage point increase, 95%CI 1.3-5.6).
Conclusion:
Inpatient costs for patients undergoing colectomy did not significantly differ in 2011 compared to 2002. Increased laparoscopy, decreased length of stay, and decreased complications were important mediators of costs savings, enabling stable costs over time. These findings highlight the increased value of inpatient colectomy over time by virtue of stable costs and improved quality.
