Rethinking Priorities: Cost of Complications After Elective Colectomy. Issue 2 (August 2016)

• Record Type: Journal Article
• Authors: Zogg, Cheryl K.; Najjar, Peter; Diaz, Arturo J. Rios; Zogg, Donald L.; Tsai, Thomas C.; Rose, John A.; Scott, John W.; Gani, Faiz; Alshaikh, Husain; Canner, Joseph K.; Schneider, Eric B.; Goldberg, Joel E.; Haider, Adil H.
• Is Part Of: Annals of surgery. Volume 264:Issue 2(2016:Aug.)
• Publication Date: 2016-08
• Subjects: colectomy -- complication -- cost -- priority setting -- surgical outcome; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001511
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses. Summary Background Data: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking. Methods: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared. Results: A total of 68, 462 patients were included, weighted to represent 337, 887 patients nationwide. A total of 16.4% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3% was due to complications [1.9% due to current Centers for Medicare and Medicaid Services (CMS) complications]. Conclusions: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way. Abstract : Supplemental Digital Content is available in the text