Postoperative complications and hospital costs following small bowel resection surgery
Autor: | Marcos Vinicius Perini, Mehrdad Nikfarjam, Ashlee Frye, Anoop N Koshy, Ronald Cw Ma, Rinaldo Bellomo, Shervin Tosif, Matthew Yii, Maleck Louis, Laurence Weinberg, Dongkyu Lee |
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Rok vydání: | 2020 |
Předmět: |
Male
Blood transfusion medicine.medical_treatment Cancer Treatment Biochemistry 0302 clinical medicine Postoperative Complications Intestine Small Medicine and Health Sciences Hospital Costs health care economics and organizations Digestive System Surgical Procedures Aged 80 and over Multidisciplinary Anemia Hematology Middle Aged Tumor Resection Colorectal surgery Clinical Laboratory Sciences Surgical Oncology Abdominal Surgery Oncology 030220 oncology & carcinogenesis Cohort Medicine 030211 gastroenterology & hepatology Female Research Article Clinical Oncology medicine.medical_specialty Science Surgical and Invasive Medical Procedures Patient Readmission 03 medical and health sciences Diagnostic Medicine medicine Humans Blood Transfusion Hemoglobin Aged Retrospective Studies Surgical Resection business.industry Transfusion Medicine Australia Biology and Life Sciences Proteins Retrospective cohort study Perioperative Length of Stay medicine.disease Surgery Clinical trial Laparoscopy Clinical Medicine business Complication |
Zdroj: | PLoS ONE PLoS ONE, Vol 15, Iss 10, p e0241020 (2020) |
ISSN: | 1932-6203 |
Popis: | BackgroundPostoperative complications after major gastrointestinal surgery are a major contributor to hospital costs. Thus, reducing postoperative complications is a key target for cost-containment strategies. We aimed to evaluate the relationship between postoperative complications and hospital costs following small bowel resection.MethodsPostoperative complications were recorded for 284 adult patients undergoing major small bowel resection surgery between January 2013 and June 2018. Complications were defined and graded according to the Clavien-Dindo classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology; it was reported in US dollars at 2019 rates. Regression modeling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs.FindingsThe overall complication prevalence was 81.6% (95% CI: 85.7-77.5). Most complications (69%) were minor, but 22.9% of patients developed a severe complication (Clavien-Dindo grades III or IV). The unadjusted median total hospital cost for patients with any complication was 70% higher than patients without complications (median [IQR] USD 19,659.64 [13,545.81-35,407.14] vs. 11,551.88 [8,849.46-15,329.87], P < 0.001). The development of 1, 2, 3, and ≥ 4 complications increased hospital costs by 11%, 41%, 50%, and 195%, respectively. Similarly, more severe complications incurred higher hospital costs (P < 0.001). After adjustments were made (for the Charlson Comorbidity Index, anemia, surgical urgency and technique, intraoperative fluid administration, blood transfusion, and hospital readmissions), a greater number and increased severity of complications were associated with a higher adjusted median hospital cost. Patients who experienced complications had an adjusted additional median cost of USD 4,187.10 (95% CI: 1,264.89-7,109.31, P = 0.005) compared to those without complications.ConclusionsPostoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following small bowel resection surgery and quantify their associated increase in hospital costs.Trial registrationAustralian Clinical Trials Registration number: 12620000322932. |
Databáze: | OpenAIRE |
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