C. K. Zogg1, E. B. Schneider1, J. Canner1, K. S. Yemul1, S. Selvarajah1, N. Nagarajan1, F. Gani1, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA
Introduction: In 2013, the United States spent $3.8 trillion on healthcare – a number projected to grow by 6.2% per year. Postoperative complications influence the cost of procedures and guidelines define them as a measure of the quality of surgical care. However, their impact on procedure costs remains obscure. This study explored increased costs associated with postoperative complications for colectomy using nationally representative data.
Methods: Data from the 2007-2011 HCUP Nationwide Inpatient Sample were queried for patients ≥18 years of age undergoing elective procedures with a primary procedure code for laparoscopic or open colectomy. Patients with the following primary diagnoses of colon cancer, diverticulosis, diverticulitis, regional enteritis, ulcerative colitis and benign neoplasm of the colon were included. Patients were assessed for isolated complications including mechanical injury to wounds and infection as well as procedural, systemic, urinary, pulmonary, gastrointestinal and cardiovascular complications. HCUP-defined weights were used to calculate nationally representative estimates for each complication, stratified by patient-demographic and hospital-level factors. Diagnosis, procedure and Charlson Comorbidity Index were also examined. Population-weighted crude and risk-adjusted generalized linear models (GLM) were used to assess for differences in non-routine discharge (binomial), in-hospital mortality (binomial), length of stay (gamma) and total cost (gamma) (Table).
Results: We identified 115,269 patients of whom 20,728 (17.9%) experienced a post-op complication. The most frequent complications were gastrointestinal (9.8%) and infectious (3.2%). Patients undergoing laparoscopic procedures experienced fewer complications, while patients with colon cancer (19.7%) and ulcerative colitis (18.7%) were at the highest risk. Adjusted GLM (Table) revealed that patients with complications were >3 times more likely to be non-routinely discharged and >5 times more likely to die. They had 77-82% longer lengths of stay and incurred 70-76% higher total costs. Median costs for post-operative complications stratified by primary diagnosis and procedure type were consistently higher among patients experiencing complications (p<0.001), with an average complication/no complication ratio of 1.48/1.00.
Conclusion: The considerable patient- and financial-burdens associated with postoperative complications emphasize the need for systemic efforts to support quality-improvement initiatives and standardized procedures based on best evidence. Preventing or reducing postoperative complications following colectomy has the potential to dramatically reduce overall costs while improving patient-centered outcomes.
