Hospital Costs Associated with Smoking in Veterans Undergoing General Surgery

Kamath, Aparna; Vaughan-Sarrazin, Mary; Weg, Mark W. Vander; Cai, Xueya; Cullen, Joseph J.; Katz, David A.

doi:10.1016/j.jamcollsurg.2012.01.056

Cited by 28 publications

(26 citation statements)

References 37 publications

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“…Finally, because we were interested in costs the year after surgery, we excluded patients who died during hospitalization, which could affect the costs of inpatient hospitalization. However, Kamath et al 10 found increased inpatient costs even after excluding those who died within 24 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In the only other study to specifically examine the effects of smoking status on inpatient surgical costs, in patients who smoked within 1 year before surgery, compared with never smokers, Kamath et al 10 found a small (approximately 4%) increase in direct inpatient costs (during and within 30 days of the index hospitalization), mediated partially by an increase in postoperative respiratory complications. Their analysis differed from ours in several respects, including surgical procedure type (general surgery only), population studied (Veterans Administration patients, predominantly male), and definition of smoking status (eg, they had no information regarding current smoking status at the time of surgery, thus their “current smokers” may have included those whom we would classify as former smokers).…”

Section: Discussionmentioning

confidence: 99%

“…A recent study of veterans undergoing general surgical procedures provided the first evidence supporting this hypothesis, finding a modest increase in direct inpatient costs in patients who had smoked within 1 year of surgery compared with never smokers. 10 Beyond helping to assess the economic effects of smoking on surgical costs and use, knowing the incremental costs and increased use associated with smoking could provide an estimate of the potential savings if effective tobacco use interventions were implemented as a part of routine surgical care.…”

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confidence: 99%

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Smoking Status and Health Care Costs in the Perioperative Period

et al. 2014

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IMPORTANCE Cigarette smoking adds an estimated $100 billion in annual incremental direct health care costs nationwide. Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear. OBJECTIVE To test the hypothesis that current and former smoking at the time of admission for inpatient surgery, compared with never smoking, are independently associated with higher incremental health care costs for the surgical episode and the first year after hospital discharge. DESIGN, SETTING, AND PARTICIPANTS This population-based, propensity-matched cohort study, with cohort membership based on smoking status (current smokers, former smokers, and never smokers) was performed at Mayo Clinic in Rochester (a tertiary care center) and included patients at least 18 years old who lived in Olmsted County, Minnesota, for at least 1 year before and after the index surgery. EXPOSURE Undergoing an inpatient surgical procedure at Mayo Clinic hospitals between April 1, 2008, and December 31, 2009. MAIN OUTCOMES AND MEASURES Total costs during the index surgical episode and 1 year after hospital discharge, with the latter standardized as costs per month. Costs were measured using the Olmsted County Healthcare Expenditure and Utilization Database, a claims-based database including information on medical resource use, associated charges, and estimated economic costs for patients receiving care at the 2 medical groups (Mayo Clinic and Olmsted Medical Center) that provide most medical services within Olmsted County, Minnesota. RESULTS Propensity matching resulted in 678 matched pairs in the current vs never smoker grouping and 945 pairs in the former vs never smoker grouping. Compared with never smokers, adjusted costs for the index hospitalization did not differ significantly for current or former smokers. However, the adjusted costs in the year after hospitalization were significantly higher for current and former smokers based on regression analysis (predicted monthly difference of $400 [95% CI, $131-$669] and $273 [95% CI, $56-$490] for current and former smokers, respectively). CONCLUSIONS AND RELEVANCE Compared with never smokers, health care costs during the first year after hospital discharge for an inpatient surgical procedure are higher in both former and current smokers, although the cost of the index hospitalization is not affected by smoking status.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Smoking Status and Health Care Costs in the Perioperative Period

et al. 2014

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“…A recent review summarized the results from multiple studies documenting the negative impact of smoking on the overall hospital care of surgical patients, including increased risk of perioperative complications, morbidity, mortality, and admission to the intensive care unit (ICU) in patients undergoing orthopedic, general surgery, plastic surgery, and cardiac procedures ( 6 – 10 ). The complications associated with smoking include wound infections, delayed wound healing, pneumonia, and myocardial infarction ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Smoking is Associated with Poorer Quality-Based Outcomes in Patients Hospitalized with Spinal Disease

et al. 2015

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Study designRetrospective cross-sectional database analysis.ObjectiveThe cost of spine surgery is growing exponentially, and cost-effectiveness is a critical consideration. Smoking has been shown to increase hospital costs in general surgery, but this impact has not been reported in patients with spinal disease. The objective of this work was to evaluate the effect of smoking on cost and complications in a large sample of patients admitted for treatment of spinal disease.MethodsIn 2012, the authors identified all inpatient admissions to all University HealthSystem Consortium (UHC) hospitals from 2005 to 2011 for spinal disease based on the principal diagnosis ICD-9-CM codes from the prospectively collected UHC database. Patient outcomes – including length of stay; complication, readmission, intensive care unit admission rates; and total cost – were compared for non-obese smokers and non-smokers using a two-sample t-test.ResultsThere were 137,537 patients, including 136,511 (122,608 non-smokers and 13,903 smokers) in the 4 largest diagnostic groups. Smoking was associated with increased complications and worse outcomes in three of these four groups. All outcomes in the two largest groups – fracture and dorsopathy – were worse in the smoking patients.ConclusionSmoking patients admitted for spinal disease in the sample had worse outcomes, increased complications, and higher costs than their non-smoking counterparts. In the current health-care climate focused on cost-effectiveness, smoking represents a potentially modifiable area for cost reduction.

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“…11 Although the prevalence of current and past smokers are higher in this cohort, most of the prior studies on veterans had similar range of current and past smokers. [24][25][26] In summary, although current guidelines do not recognize cigarette smoking as a risk factor for the development of BO, the present study indicates smoking (including past and current) as an independent risk factor for the development of BO. 1,13 The risk of BO significantly increases with the intensity of smoking (pack years), whereas smoking cessation of 20 years or more diminishes this risk.…”

Section: Discussionmentioning

confidence: 76%

Cigarette smoking is a modifiable risk factor for Barrett's oesophagus

et al. 2013

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Background: Cigarette smoking has been associated with an increased risk of oesophageal adenocarcinoma (OAC). However, the impact of smoking and more importantly smoking cessation on Barrett's oesophagus (BO) is unclear. Objective: The aim of the study is to evaluate the association between cigarette smoking and presence of BO in a large prospective cohort of patients with gastro-oesophageal reflux disease (GORD). Methods: Patients presenting to the endoscopy unit for upper endoscopy completed a validated GORD questionnaire and information on demographics (age, gender, and ethnicity), cigarette smoking [status (current/past), amount (pack years) and duration of smoking cessation], clinical data [medication history, body mass index (BMI), and family history] and endoscopic findings [BO and hiatal hernia] were recorded. Cigarette smokers (current and past) and nonsmokers were compared using Fisher's Exact test for categorical variables and Mann-Whitney test for continuous variables. Effects of cigarette smoking and smoking cessation on BO risk was assessed by stepwise logistic regression analysis. Results: A total of 1056 patients were included in the analysis [mean age: 57.2 AE 12.7years, Caucasian 880 (83.3%), male 985 (93.3%), and mean BMI 29.6 (SD: AE 5.6)]. 827 (78.3%) were smokers and 229 (21.6%) were nonsmokers. 474 subjects (44.9%) had a previous history of smoking. Anytime smokers were more likely to have BO (adjusted OR: 3.3; 95 CI: 1.7-6.3; p < 0.01). Higher smoking burden (pack years) was associated with higher risk of BO in this GORD cohort (p for trend < 0.01). Duration of smoking cessation was inversely associated with risk of BO (p for trend: 0.01). Conclusion: This study shows that smokers with reflux symptoms have about threefold higher risk of BO compared with nonsmokers, whereas discontinuing smoking is associated with a significant reduced risk. Smoking cessation appears to be a viable option to reduce BO risk in patients with reflux disease.

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Hospital Costs Associated with Smoking in Veterans Undergoing General Surgery

Cited by 28 publications

References 37 publications

Smoking Status and Health Care Costs in the Perioperative Period

Smoking Status and Health Care Costs in the Perioperative Period

Smoking is Associated with Poorer Quality-Based Outcomes in Patients Hospitalized with Spinal Disease

Cigarette smoking is a modifiable risk factor for Barrett's oesophagus

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