Cost of cystectomy-related complications in patients with bladder cancer in the United States

Malangone-Monaco, Elisabetta; Wilson, Kathleen; Diakun, David; Tayama, Darren; Satram, Sacha; Ogale, Sarika

doi:10.1080/03007995.2020.1758927

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…Our findings of increased hospital costs in patients with postoperative complications are consistent with those in the previous studies [8,10,12]. In their study, Leow et al identified postoperative complications as the most significant contributor to hospital costs and found that increased complication severity was a risk factor for high hospital costs [12].…”

Section: Plos Onesupporting

confidence: 91%

“…In their study, Leow et al identified postoperative complications as the most significant contributor to hospital costs and found that increased complication severity was a risk factor for high hospital costs [12]. Further studies have similarly observed a positive correlation between hospital costs and the number and severity of complications [8,10]. Our study adds to this body of literature by quantifying the cost increase associated with the increased number and severity of complications.…”

Section: Plos Onementioning

confidence: 52%

“…With this definitive approach, the 5-year median survival increases by 15%-30% [6]. However, RC carries a high risk of postoperative complications [7][8][9][10][11], which in turn can contribute substantially to healthcare cost [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, understanding the cost breakdown of postoperative complications associated with RC will enable the use of targeted preventative strategies to improve patient outcomes and reduce expenditure. At present, there have been few studies investigating the association between hospital costs after RC and both the number and severity of postoperative complications [8,10]. Further, existing studies have relied solely on hospital administrative coding data to determine the number and severity of complications without accessing patient records to confirm the accuracy of these data.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative complications and hospital costs following open radical cystectomy: A retrospective study

et al. 2023

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Objectives To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy. Methods Postoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien–Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model. Results 135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9–53,532.5) and $81,050.1 (49,614.8–122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%–76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%–181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08–1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23–5.07) respectively. Conclusions These findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies. Trial registration Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN:12622000057785.

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Section: Plos Onesupporting

confidence: 91%

Section: Plos Onementioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative complications and hospital costs following open radical cystectomy: A retrospective study

et al. 2023

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“…To date, several studies have reported postoperative complications after RC, and these results are summarized in Table 3 [24][25][26][27][28]. Studies have reported that the rate of paralytic ileus ranged from 7.1% to 22.2%, which is slightly lower than the rate reported in our study (26.1%).…”

Section: Discussioncontrasting

confidence: 61%

Feasibility and Safety of Stentless Uretero-Intestinal Anastomosis in Radical Cystectomy with Ileal Orthotopic Neobladder

Lee

et al. 2021

JCM

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Background: We evaluated the feasibility and safety of stentless uretero-intestinal anastomosis (UIA) during radical cystectomy (RC) with an ileal orthotopic neobladder. Methods: We retrospectively reviewed 403 patients who underwent RC for bladder cancer between August 2014 and December 2018. The primary objective was to study the effect of stentless UIA on uretero-intestinal anastomosis stricture (UIAS), and the secondary objective was to evaluate the association between stentless UIA and other complications, including paralytic ileus, febrile urinary tract infection (UTI), and urine leakage. Kaplan–Meier survival analysis was used to estimate UIAS-free survival, and Cox proportional hazard models were applied to identify factors associated with the risk of UIAS. Results: Among 403 patients with 790 renal units, UIAS was identified in 39 (9.7%) patients and 53 (6.7%) renal units. Forty-four (83.0%) patients with UIAS were diagnosed within 6 months. The 1- and 2-year overall UIAS-free rates were 93.9% and 92.7%, respectively. Paralytic ileus was identified in 105 (26.1%) patients and resolved with supportive treatment. Febrile UTI occurred in 57 patients (14.1%). However, there was no leak of the UIA. Conclusions: Stentless UIA during RC with an ileal orthotopic neobladder is a feasible and safe surgical option. Further prospective randomized trials are required to determine the clinical usefulness of stentless UIA during RC.

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Cost-Effectiveness and Economic Impact of Bladder Cancer Management: An Updated Review of the Literature

2023

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Cost of cystectomy-related complications in patients with bladder cancer in the United States

Cited by 8 publications

References 28 publications

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study

Feasibility and Safety of Stentless Uretero-Intestinal Anastomosis in Radical Cystectomy with Ileal Orthotopic Neobladder

Cost-Effectiveness and Economic Impact of Bladder Cancer Management: An Updated Review of the Literature

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