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
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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