For whom the bell tolls: assessing the incremental costs associated with failure to rescue after elective colorectal surgery.

Autor:	Schultz KS; Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States., Moore MS; Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States., Pantel HJ; Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States., Mongiu AK; Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States., Reddy VB; Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States., Schneider EB; Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States., Leeds IL; Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States. Electronic address: Ira.Leeds@yale.edu.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Nov; Vol. 28 (11), pp. 1812-1818. Date of Electronic Publication: 2024 Aug 22.
DOI:	10.1016/j.gassur.2024.08.019
Abstrakt:	Background: Failure to rescue after elective surgery is associated with increased healthcare costs. These costs are poorly understood and have not been reported for colorectal surgery. This study aimed to assess the incremental costs of failure to rescue after elective colorectal surgery. Methods: This was a retrospective study of adult patients identified in the National Inpatient Sample from 2016 to 2019 who underwent an elective colectomy or proctectomy. Patients were stratified into 4 groups: uneventful recovery, successfully rescued, failure to rescue, and died without rescue attempts. "Rescue" was defined as admissions with ≥1 procedure code ≥1 day after the initial procedure. The primary outcome was total admission costs. Results: Of 451,490 admissions for elective colorectal resection, 94.6% had an uneventful recovery, 4.8% were successfully rescued, 0.4% were failure to rescue, and 0.3% died without rescue attempts. The median total hospital cost for the uneventful recovery cohort was $16,751 (IQR, $12,611-$23,116), for the successfully rescued cohort was $42,295 (IQR, $27,959-$67,077), for the failure-to-rescue cohort was $53,182 (IQR, $30,852-$95,615), and for the died without attempted rescue cohort was $29,296 (IQR, $19,812-$45,919). When comparing cost quantiles by regression analysis, failure-to-rescue patients had significantly higher costs than the successfully rescued patients for the last 3 quantiles (fifth quantile [90th percentile], $163,963 vs $106,521; P < .001). Conclusion: Across a nationally representative cohort, the median total hospital costs for patients who failed to be rescued were $10,887 more than for those who were successfully rescued. These findings emphasize the importance of shared decision making and medical futility and highlight opportunities for resource optimization after postoperative complications. (Published by Elsevier Inc.)
Databáze:	MEDLINE
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