The Cost Burden of Complications after Major Surgery for Urological Cancer: Opportunities for Value Creation in Urology. Issue 2 (March 2016)

• Record Type: Journal Article
• Authors: Tan, Hung‐Jui; Kaplan, Alan L.; Chuang, Ryan J.; Kwan, Lorna; Filson, Christopher P.; Litwin, Mark S.
• Is Part Of: Urology practice. Volume 3:Issue 2(2016)
• Publication Date: 2016-03
• Subjects: costs and cost analysis -- urinary bladder neoplasms -- kidney neoplasms -- prostatic neoplasms -- postoperative complications
• DOI: 10.1016/j.urpr.2015.05.002
• Languages: English
• ISSNs: 2352-0779

Abstract

Abstract : Introduction : While improving patient outcomes and controlling costs have become primary pursuits in health care, priority areas for value creation remain unclear. In urology operative morbidity serves as a major barrier to high value care. To guide improvement efforts we assessed the prevalence and cost of inpatient complications among patients undergoing major surgery for urological cancer. Methods : Using the Nationwide Inpatient Sample from 2009 to 2011 we identified hospital admissions for cancer related prostatectomy, nephrectomy and cystectomy among adults age 18 years or older. We then measured the occurrence of inpatient complications, medical and surgical, and used multivariable, mixed effect models to estimate the associated marginal cost. Results : Among weighted samples of 229, 743 prostatectomies, 111, 683 nephrectomies and 31, 213 cystectomies, inpatient complications occurred in 9.4% (95% CI 8.6–10.2), 32.0% (95% CI 30.7–33.4) and 57.7% (95% CI 54.7–60.6) of hospital admissions, respectively. For these respective samples an adverse event added $4, 947 (95% CI 4, 523–5, 454), $6, 782 (95% CI 6, 336–7, 293) and $10, 756 (95% CI 9, 999–11, 759) to the cost of inpatient care. While surgical events occurred most frequently, medical complications generated $1, 699 (95% CI 994–2, 423), $2, 052 (95% CI 1, 545–2, 662) and $4, 852 (95% CI 3, 519–6, 531) more in expense per episode for prostate, kidney and bladder cancer cases, respectively. Conclusions : Many patients undergoing major surgery for urological cancer experience a complication, adding substantially to health care costs. As urologists seek to generate value in urological cancer care, the prevention and management of complications, especially medically driven events, represent an immediate opportunity for quality improvement and cost savings.