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dc.contributor.authorLee, D-K
dc.contributor.authorFrye, A
dc.contributor.authorLouis, M
dc.contributor.authorKoshy, AN
dc.contributor.authorTosif, S
dc.contributor.authorYii, M
dc.contributor.authorMa, R
dc.contributor.authorNikfarjam, M
dc.contributor.authorPerini, MV
dc.contributor.authorBellomo, R
dc.contributor.authorWeinberg, L
dc.date.accessioned2020-11-17T04:09:54Z
dc.date.available2020-11-17T04:09:54Z
dc.date.issued2020-10-21
dc.identifierpii: PONE-D-20-23870
dc.identifier.citationLee, 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.
dc.identifier.issn1932-6203
dc.identifier.urihttp://hdl.handle.net/11343/251720
dc.description.abstractBACKGROUND: 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.
dc.languageEnglish
dc.publisherPUBLIC LIBRARY SCIENCE
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titlePostoperative complications and hospital costs following small bowel resection surgery
dc.typeJournal Article
dc.identifier.doi10.1371/journal.pone.0241020
melbourne.affiliation.departmentMedicine (Austin & Northern Health)
melbourne.affiliation.departmentSurgery (Austin & Northern Health)
melbourne.affiliation.departmentCritical Care
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titlePLoS One
melbourne.source.volume15
melbourne.source.issue10
melbourne.source.pagese0241020-
dc.rights.licenseCC BY
melbourne.elementsid1469250
melbourne.openaccess.pmchttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577438
melbourne.contributor.authorWeinberg, Laurence
melbourne.contributor.authorNikfarjam, Mehrdad
melbourne.contributor.authorBellomo, Rinaldo
melbourne.contributor.authorPerini, Marcos
melbourne.contributor.authorKoshy, Anoop
melbourne.contributor.authorMa, Ronald
dc.identifier.eissn1932-6203
melbourne.accessrightsOpen Access


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