Key result
Postoperative complications are linked to a ~50% increase in direct hospital costs.
Why the study?
The extent of hospital cost increases due to specific surgical complications has not been well described.
Does the occurrence of postoperative complications increase direct hospital costs in surgical patients?
Cohort (n=11,897)
No
Does the occurrence of postoperative complications increase direct hospital costs in surgical patients?
Effect estimate: 1.5-fold increase (95% CI 1.49-1.58)
Postoperative complications significantly increase direct hospital costs, highlighting the financial value of complication prevention and preoperative optimization.
Complications were associated with higher costs; leaves open whether prevention reduces expenditures in surgical populations.
OBJECTIVE: Surgical complications have substantial impact on healthcare costs. We propose an analysis of the financial impact of postoperative complications. SUMMARY OF BACKGROUND DATA: Both complications and preoperative patient risk have been shown to increase costs following surgery. The extent of cost increase due to specific complications has not been well described. METHODS: A single institution's American College of Surgeons National Surgical Quality Improvement Program data was queried from 2012 to 2018 and merged with institutional cost data for each encounter. A mixed effects multivariable generalized linear model was used to estimate the mean relative increase in hospital cost due to each complication, adjusting for patient and procedure-level fixed effects clustered by procedure. Potential savings were calculated based on projected decreases in complication rates and theoretical hospital volume. RESULTS: There were 11,897 patients linked between the 2 databases. The rate of any American College of Surgeons National Surgical Quality Improvement Program complication was 11.7%. The occurrence of any complication resulted in a 1.5-fold mean increase in direct hospital cost [95% confidence interval (CI) 1.49-1.58]. The top 6 most costly complications were postoperative septic shock (4.0-fold, 95% CI 3.58-4.43) renal insufficiency/failure (3.3-fold, 95% CI 2.91-3.65), any respiratory complication (3.1-fold, 95% CI 2.94-3.36), cardiac arrest (3.0-fold, 95% CI 2.64-3.46), myocardial infarction (2.9-fold, 95% CI 2.43-3.42) and mortality within 30 days (2.2-fold, 95% CI 2.01-2.48). Length of stay (6.5 versus 3.2 days, P < 0.01), readmission rate (29.1% vs 3.1%, P < 0.01), and discharge destination outside of home (20.5% vs 2.7%, P < 0.01) were significantly higher in the population who experienced complications. CONCLUSIONS: Decreasing complication rates through preoperative optimization will improve patient outcomes and lead to substantial cost savings.
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Stokes et al. (2022) conducted a cohort in Surgical complications (n=11,897). Postoperative complications vs. No complications was evaluated on Direct hospital cost (1.5-fold increase, 95% CI 1.49-1.58). The occurrence of any postoperative complication resulted in a 1.5-fold mean increase in direct hospital cost (95% CI 1.49-1.58).
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