The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients.

Details

Serval ID
serval:BIB_E6F458E80C73
Type
Article: article from journal or magazin.
Collection
Publications
Title
The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients.
Journal
Annals of Surgery
Author(s)
Vonlanthen R., Slankamenac K., Breitenstein S., Puhan M.A., Muller M.K., Hahnloser D., Hauri D., Graf R., Clavien P.A.
ISSN
1528-1140 (Electronic)
ISSN-L
0003-4932
Publication state
Published
Issued date
2011
Volume
254
Number
6
Pages
907-913
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
OBJECTIVE: To assess the impact of postoperative complications on full in-hospital costs per case.
BACKGROUND: Rising expenses for complex medical procedures combined with constrained resources represent a major challenge. The severity of postoperative complications reflects surgical outcomes. The magnitude of the cost created by negative outcomes is unclear.
PATIENTS AND METHODS: Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary, high-volume center was assessed by a validated, complication score system. Full in-hospital costs were collected for each patient. Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders.
RESULTS: This study population included 393 complex liver/bile duct surgeries, 110 major pancreas operations, 389 colon resections, and 308 Roux-en-Y gastric bypasses. The overall 30-day mortality rate was 1.8%, whereas morbidity was 53.8%. Patients with an uneventful course had mean costs per case of US$ 27,946 (SD US$ 15,106). Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 (SD US$ 151,191) for grade IV complications. This increase in costs, up to 5 times the cost of a similar operation without complications, was observed for all types of investigated procedures, although the magnitude of the increase varied, with the highest costs in patients undergoing pancreas surgery.
CONCLUSION: This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs. Furthermore, the study highlights a relevant savings capacity for major surgical procedures, and supports all efforts to lower negative events in the postoperative course.
Keywords
Adult, Aged, Aged, 80 and over, Anastomosis, Roux-en-Y/economics, Bile Duct Diseases/economics, Bile Duct Diseases/surgery, Cohort Studies, Colectomy/economics, Colonic Diseases/economics, Colonic Diseases/surgery, Costs and Cost Analysis, Female, Gastric Bypass/economics, Hospital Costs/statistics & numerical data, Humans, Liver Diseases/economics, Liver Diseases/surgery, Male, Middle Aged, Pancreatic Diseases/economics, Pancreatic Diseases/surgery, Postoperative Complications/economics, Postoperative Complications/mortality, Prospective Studies, Quality of Health Care/economics, Surgical Procedures, Operative/economics, Surgical Procedures, Operative/mortality, Survival Rate, Young Adult
Pubmed
Web of science
Create date
07/10/2014 14:18
Last modification date
20/08/2019 16:10
Usage data