What question did this study set out to answer?

To evaluate the financial expenditure associated with postoperative complications and assess hospital profit-loss under the Payment by Results reimbursement system.

August 8, 2025British Journal of AnaesthesiaOpen Access

The financial cost of postoperative complications: a prospective cohort study with linked health systems data

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Why the study?

One in five patients experience postoperative complications, but the economic cost of these complications is poorly understood.

Do postoperative complications increase healthcare costs in patients undergoing surgery?

Population

5167 patients undergoing surgery in the NHS in England

Comparison

Patients with postoperative complications vs patients without complications

Design

Prospective cohort study with linked health systems data

Authors

SWSarah-Louise WatsonQueen Mary University of London AFAlexander J. FowlerCochlear (Australia)RPRupert M. PearseUniversity College Dublin

Discussion

Member takes

Implication

Complications after surgery drive substantial NHS costs; leaves open whether prevention strategies yield net savings.

Key Points

To evaluate the financial expenditure associated with postoperative complications and assess hospital profit-loss under the Payment by Results reimbursement system.
Planned analysis linking data from the prospective International Surgical Outcomes Study with NHS England Hospital Episode Statistics across N=5167 surgical patients.
Expenditure was calculated from ward and critical care length of stay multiplied by daily unit costs, and income was defined using the Payment by Results tariff.
Postoperative complications occurred in 16.4% (848/5167) of patients, extending median length of stay from 2 days to 7 days.
Average admission expenditure increased by approximately 200% from £1038 (95% CI: £1006–1070) in patients without complications to £3100 (95% CI: £2921–3279) in patients with complications.
Most surgical procedures generated a financial loss regardless of complication status, averaging a £930 loss (95% CI: £866–995) without complications and an £850 loss (95% CI: £629–1071) with complications.

Structured PICO

Do postoperative complications increase healthcare costs in patients undergoing surgery?

Population

5167 patients undergoing surgery in the NHS in England, mean age 58.9 years, 58.1% female, 41.9% male.

Intervention

Postoperative complications

Comparator

No postoperative complications

Outcome

Cost of postoperative complications

Postoperative complications increase hospital expenditure by approximately 200%, though most surgical procedures result in a financial loss for the hospital regardless of complications under the PbR system.

Cite This Study

Watson et al. (2025) studied this question.

synapsesocial.com/papers/6a7952598d250a4360f37bc0 https://doi.org/10.1016/j.bja.2025.06.039

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The financial cost of postoperative complications: a prospective cohort study with linked health systems data

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

The financial cost of postoperative complications: a prospective cohort study with linked health systems data

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider