Economic consequences of postoperative complications based on the STOPRISK study: complication analysis and scenario modelling

INTRODUCTION: Postoperative complications under diagnosis-related group (DRG) reimbursement increase hospital costs and prolong ward and intensive care unit (ICU) stay, which additional payments may not fully offset. OBJECTIVES: To quantify the impact of complications on hospital and ICU length of stay (LOS, ICU LOS), estimate related hospital costs, and model the economic effect of a risk prediction model. MATERIALS AND METHODS: Retrospective multicentre cohort study of the STOPRISK registry (n = 11,081 episodes). Complications were defined by 19 binary indicators (18 tabulated). Outcomes: LOS, ICU LOS and in-hospital mortality as median (Q1; Q3). Economic modelling was an exploratory scenario cost–consequence analysis with return on investment (ROI) from the hospital perspective; resource cost equivalents 6,040 RUB/ward day and 66,225 RUB/ICU day. RESULTS: Complications occurred in 508/11,081 (4.58 %), death in 70 (0.63 %) and ICU stay in 3,428 (30.9 %); 946 events were recorded (1.86 per affected patient). All 18 complications had higher median LOS and ICU LOS; the largest increases were wound dehiscence (+23 days), sepsis (+19) and pulmonary embolism (+18). Additional resource costs per event were 109,000–777,000 RUB; the total annual event-related burden was 328.2 million RUB. In the base-case A + B scenario (δ = 20 %) annual savings were 54.1 million RUB, ROI 10.8× and payback 1.1 months; across the δ = 10–30 % range, 29.8–73.0 million RUB, ROI 6.0–24.3× and 0.5–2.0 months. Complication rates were 3.14 % (< 65 years) and 8.06 % (≥ 65 years); failure-to-rescue ≈13.8 %. CONCLUSIONS: Postoperative complications generate substantial event-related resource burden through longer LOS and ICU LOS, with patients ≥ 65 years contributing a disproportionately high share of costs. Under the specified assumptions, risk stratification and clinical pathways may be economically justified from the hospital perspective; the benefit depends on actual use of the tool, case-mix, tariffs and ICU occupancy. The findings are exploratory and require prospective validation.