S. M. Stokes1, B. S. Brooke2, R. E. Glasgow1, S. R. Finlayson1, T. K. Varghese3 1University Of Utah,Department Of Surgery, Division of General Surgery,Salt Lake City, UT, USA 2University Of Utah,Department Of Surgery, Division Of Vascular Surgery,Salt Lake City, UT, USA 3University Of Utah,Department Of Surgery, Division Of Cardiothoracic Surgery,Salt Lake City, UT, USA
Introduction: Respiratory complications following high and intermediate-risk surgeries are known to have a substantial impact on a patient’s clinical post-operative course, although the resulting financial impact on the health care system is not well characterized. The objective of this study was to assess hospital costs when patient’s experience respiratory complications.
Methods: A single institution’s database was queried to identify all patients undergoing elective intermediate (colectomy, lung resection, infra-inguinal bypass, carotid endarterectomy, and ventral hernia repair) and high-risk (esophagectomy, pancreatectomy, valve replacement, coronary bypass, and open abdominal aorta) surgeries. Urgent and emergent operations were excluded. Patient demographic, inpatient, and direct cost data were collected. The primary outcome measure was the proportional increase in total cost due to a pneumonia complication, expressed as the relative increase of the total hospital cost between pneumonia and non-pneumonia cases. Secondary outcomes were cost divisions between facility, lab, imaging, and supply costs, as well as surgical outcomes. Mixed-effects, multivariate, regression models were constructed, with patients clustered by procedure, to identify independent risk factors associated with increased hospital costs of treating pulmonary complications.
Results: We identified a total of 2,834 patients who underwent at least one of the ten selected elective surgeries. The rates of pneumonia were greater for high-risk procedures (9.3% vs. 3.8%, p < 0.001) as compared to intermediate procedures. After adjustment in regression models, the occurrence of pneumonia was found to result in an overall 1.5-fold increase in hospital costs. This cost difference was greater for intermediate-risk (1.8-fold) vs. high-risk (1.3-fold) surgeries. For high-risk procedures, pneumonia, length of stay, ASA class, and surgery length all predisposed to higher hospital costs (p<0.05 for all associations). For intermediate-risk procedures, pneumonia, failure to wean from mechanical ventilation, length of stay, Charlson-Deyo comorbidity index, and surgery length predisposed to higher hospital costs (p<0.001 for all associations). In patients who experienced a pneumonia complication, the largest contribution to costs was facility cost (33%), followed by pharmacy (19%), other services (15%), and laboratory costs (12%).
Conclusion: Our data shows that respiratory complications have a profound impact on hospital costs, especially for intermediate-risk procedures. Focusing efforts on preventing respiratory complications can have a significant impact on both patient outcomes and the financial burden to the healthcare system.
