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A Comprehensive Estimation of the Costs of 30-Day Postoperative Complications Using Actual Costs from Multiple, Diverse Hospitals

Published:September 02, 2020DOI:https://doi.org/10.1016/j.jcjq.2020.06.011

      Background

      The cost of surgical care is largely measured by charges or payments, both of which are inadequate. Actual cost data from the hospital's perspective are required to accurately quantify the financial return on investment of engaging in quality improvement. The objective of this study was to define the cost of individual, 30-day postoperative complications using robust cost data from a diverse group of hospitals.

      Methods

      Using clinical data derived from the American College of Surgeons National Surgical Quality Improvement Program, this retrospective study assessed postoperative complications for patients who underwent surgery at one of four hospitals in 2016. Actual direct and indirect 30-day costs were obtained, and the adjusted cost per complication was determined.

      Results

      From the 6,387 patients identified, the three complications associated with the highest independent adjusted cost per event were prolonged ventilation ($48,168; 95% confidence interval [CI]: $21,861–$74,476), unplanned intubation ($26,718; 95% CI: $15,374–$38,062), and renal failure ($18,528; CI: $17,076–$19,981). The three complications associated with the lowest independent adjusted cost per event were urinary tract infection (-$372; 95% CI: -$1,336–$592), superficial surgical site infection ($2,473; 95% CI: -$256–$5,201) and venous thromboembolism ($7,909; 95% CI: -$17,903–$33,721). After colectomy, the adjusted independent cost of anastomotic leak was $10,195 (95% CI: $5,941–$14,449), while the cost of postoperative ileus was $10,205 (95% CI: $6,259–$14,149).

      Conclusion

      The actual hospital costs of complications were estimated using cost data from four diverse hospitals. These data can be used by hospitals to estimate the financial benefit of reducing surgical complications.
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      References

        • Health Care Cost Institute
        Health Care Cost and Utilization Report. 2018; (Feb 2020. Accessed Jul 7, 2020.)
        • Muñoz E
        • Muñoz 3rd, W
        • Wise L
        National and surgical health care expenditures, 2005–2025.
        Ann Surg. 2010; 251: 195-200
        • Eappen S
        • et al.
        Relationship between occurrence of surgical complications and hospital finances.
        JAMA. 2013 Apr 17; 309: 1599-1606
        • Vonlanthen R
        • et al.
        The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients.
        Ann Surg. 2011; 254: 907-913
        • Jean RA
        • et al.
        Hospital variation in spending for lung cancer resection in Medicare beneficiaries.
        Ann Thorac Surg. 2019; 108: 1710-1716
        • Bennett KM
        • et al.
        Targeting the most important complications in vascular surgery.
        J Vasc Surg. 2017; 65: 793-803
        • Pradarelli JC
        • et al.
        Variation in Medicare expenditures for treating perioperative complications: the cost of rescue.
        JAMA Surg. 2016 Dec 21; 151e163340
        • American College of Surgeons
        User Guide for the 2016 ACS NSQIP Participant Use Data File (PUF).
        Oct 2017 (Accessed Jul 7, 2020.)
        • Bilimoria KY
        • et al.
        Comparison of outlier identification methods in hospital surgical quality improvement programs.
        J Gastrointest Surg. 2010; 14: 1600-1607
        • Cohen ME
        • et al.
        Risk adjustment in the American College of Surgeons National Surgical Quality Improvement Program: a comparison of logistic versus hierarchical modeling.
        J Am Coll Surg. 2009; 209: 687-693
        • Cohen ME
        • et al.
        Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus.
        J Am Coll Surg. 2013; 217: 336-346.e1
        • Dimick JB
        • et al.
        Reliability adjustment for reporting hospital outcomes with surgery.
        Ann Surg. 2012; 255: 703-707
        • Dimick JB
        • et al.
        Risk adjustment for comparing hospital quality with surgery: how many variables are needed?.
        J Am Coll Surg. 2010; 210: 503-508
        • Hall BL
        • et al.
        Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals.
        Ann Surg. 2009; 250: 363-376
        • Ingraham AM
        • et al.
        Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach.
        Adv Surg. 2010; 44: 251-267
        • Khuri SF.
        The NSQIP: a new frontier in surgery.
        Surgery. 2005; 138: 837-843
        • Sellers MM
        • et al.
        Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program.
        J Am Coll Surg. 2013; 216: 420-427
        • Merkow RP
        • et al.
        Post-discharge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis.
        Ann Surg. 2011; 254: 131-137
        • Merkow RP
        • et al.
        Underlying reasons associated with hospital readmission following surgery in the United States.
        JAMA. 2015 Feb 3; 313: 483-495
        • American College of Surgeons
        User Guide for the 2016 ACS NSQIP Procedure Targeted Participant Use Data File (PUF).
        Updated Version. Dec 2017; (Accessed Jul 7, 2020)
        • Austin PC
        • Ghali WA
        • Tu JV
        A comparison of several regression models for analysing cost of CABG surgery.
        Stat Med. 2003 Sep 15; 22: 2799-2815
        • Malehi AS
        • Pourmotahari F
        • Angali KA
        Statistical models for the analysis of skewed healthcare cost data: a simulation study.
        Health Econ Rev. 2015 May 27; 5: 11
        • Blough DK
        • Madden CW
        • Hornbrook MC
        Modeling risk using generalized linear models.
        J Health Econ. 1999; 18: 153-171
        • Manning WG
        • Basu A
        • Mullahy J
        Generalized modeling approaches to risk adjustment of skewed outcomes data.
        J Health Econ. 2005; 24: 465-488
        • Basu A
        • Rathouz PJ.
        Estimating marginal and incremental effects on health outcomes using flexible link and variance function models.
        Biostatistics. 2005; 6: 93-109
        • Dimick JB
        • et al.
        Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program.
        J Am Coll Surg. 2004; 199: 531-537
        • Healy MA
        • et al.
        Hospital and payer costs associated with surgical complications.
        JAMA Surg. 2016 Sep 1; 151: 823-830
        • Grass F
        • et al.
        Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study.
        Int J Colorectal Dis. 2017; 32: 675-681
        • Arora V
        • Moriates C
        • Shah N
        The challenge of understanding health care costs and charges.
        AMA J Ethics. 2015 Nov 1; 17: 1046-1052
        • Centers for Medicare & Medicaid Services
        MS-DRG Classifications and Software.
        2020 (Updated: May 11.) Accessed Jul 7, 2020.
        • Brooke BS
        • et al.
        Readmission destination and risk of mortality after major surgery: an observational cohort study.
        Lancet. 2015 Aug 29; 386: 884-895
        • Tsai TC
        • Orav EJ
        • Jha AK
        Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality.
        JAMA Surg. 2015; 150: 59-64