Postoperative complications and hospital costs following small bowel resection surgery
AuthorLee, D-K; Frye, A; Louis, M; Koshy, AN; Tosif, S; Yii, M; Ma, R; Nikfarjam, M; Perini, MV; Bellomo, R; ...
Source TitlePLoS One
PublisherPUBLIC LIBRARY SCIENCE
University of Melbourne Author/sWeinberg, Laurence; Nikfarjam, Mehrdad; Bellomo, Rinaldo; Perini, Marcos; Koshy, Anoop; Ma, Ronald
AffiliationMedicine (Austin & Northern Health)
Surgery (Austin & Northern Health)
Document TypeJournal Article
CitationsLee, D. -K., Frye, A., Louis, M., Koshy, A. N., Tosif, S., Yii, M., Ma, R., Nikfarjam, M., Perini, M. V., Bellomo, R. & Weinberg, L. (2020). Postoperative complications and hospital costs following small bowel resection surgery. PLOS ONE, 15 (10), https://doi.org/10.1371/journal.pone.0241020.
Access StatusOpen Access
Open Access at PMChttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577438
BACKGROUND: Postoperative 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. METHODS: Postoperative 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. FINDINGS: The 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. CONCLUSIONS: Postoperative 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 REGISTRATION: Australian Clinical Trials Registration number: 12620000322932.
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