A. E. Kanters1, A. Cain-Nielsen2, S. Regenbogen1 1University Of Michigan,General Surgery,Ann Arbor, MI, USA 2University Of Michigan,Center For Healthcare Outcomes And Policy,Ann Arbor, MI, USA
Introduction: With increasing scrutiny on total spending for episodes of care, it is recognized that post-acute care (PAC) is the principal source of variation in payments around surgery. Studies have demonstrated that hospital quality is associated with episode spending, however the extent to which quality improvement measures to decrease postoperative complications can affect PAC costs has not been quantified.
Methods: This cross-sectional cohort study included Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting (CABG), or total hip replacement (THR) between January 2009 and June 2012. Each patient with a recorded postoperative complication was matched 1:1 with one who underwent the same operation, but without complication, according to preoperative predictors of PAC spending (including Elixhauser comorbidities, age and type of admission). We computed average prize-standardized PAC spending within 90 days from index operation and compared adjusted payments and rates of use of each type of PAC between those with and without complications. PACs were dichotomized as inpatient (skilled nursing facility [SNF], inpatient rehabilitation [IPR], or long term acute care [LTAC]) versus outpatient settings (outpatient rehabilitation [OPR] or home health [HH]).
Results: After risk-matching, 73,858 CABG patients, 62,948 colectomy patients, and 3,192 THR patients were included. Price-standardized PAC payments increased $5,590 for CABG (p<0.001), $6,600 for colectomy (p<0.001), and $2,051 for THR patients (p<0.001) with postoperative complications. Among patients with complications, the likelihood of inpatient PAC was increased by 9.6% after CABG (p<0.001), 7.3% after colectomy (p<0.001), and 5.3% after THR (p=0.001); accordingly, there was a decrease in likelihood of outpatient PAC by 10.4% after CABG (p<0.001) and 6.2% after colectomy (p<0.001). There was no significant change in outpatient PAC utilization for THR patients (Figure).
Conclusion: Postoperative complications after major surgery are associated with significantly greater PAC spending, and increased use of high-cost, inpatient care settings. Reductions in PAC spending will be central to hospitals’ efforts to reduce episode costs around major surgery. Thus, quality improvement efforts that reduce postoperative complications will be a key component of success in emerging payment reform.
