January 1, 2015Open Access

Hospital Cost-Analysis of Complications after Major Abdominal Surgery

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Major abdominal surgery (n=399). Intervention: Major complications vs. Uncomplicated postoperative course. Primary outcome: Adjusted total hospital costs (EUR) (95% CI 27,187.13-31,295.78, p=<0.001).

Key Result

Major complications after major abdominal surgery significantly increased adjusted hospital costs to EUR 29,198.23 compared to EUR 8,584.81 for an uncomplicated postoperative course.

Study Design

Type

Cohort (n=399)

Multicenter

PICO

Population

Major abdominal surgery (n=399)

Intervention / Comparator

Major complications vs Uncomplicated postoperative course

Primary Outcome

Adjusted total hospital costs (EUR) (27,187.13-31,295.78), p=<0.001

Main Result

Absolute Event Rate: 29198.23% vs 8584.81%

p-value: p=<0.001

Limitations

Data derived from a single University teaching hospital, which might affect external validity
Data regarding laboratory testing other than CRP, WBC and hemoglobin was not available
Data regarding off-hour surgery was not available
Only costs within the hospital were considered, excluding out-of-hospital care and delay in return to work
Observational nature of the study

Abstract

BACKGROUND: Complications after major abdominal surgery (MAS) are associated with increased morbidity and mortality. Rising costs in health care are of increasing interest and a major factor affecting hospital costs are postoperative complications. In this study, the costs associated with complications are assessed. METHODS: Retrospective cohort study of 399 consecutive patients that underwent MAS. Analysis of total costs for hospital stay, complications and treatment was performed, including bootstrapping; allowing for subtraction of data with 95% confidence intervals. RESULTS: For a single patient who underwent MAS the average costs, adjusted for ASA-classification and surgery type, adds up to EUR 8,584.81 (95% CI EUR 8,332.51 - EUR 8,860.81) in patients without complications. EUR 15,412.96 (95% CI EUR 14,250.22 - EUR 16,708.82) after minor complications, and EUR 29,198.23 (95% CI EUR 27,187.13 - EUR 31,295.78) after major complications (p < 0.001). CONCLUSION: The results provide an insight into the scope of hospital costs associated with complications. Major complications occur in 20% of patients undergoing MAS and account for 50% of the total costs of care. Implementation of a protocol aimed at early diagnosis and treatment of complications might lead to a decrease in morbidity and mortality, but also prove to be cost effective.

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