Hospital costs associated with surgical morbidity after elective colorectal procedures: a retrospective observational cohort study in 530 patients

Abstract

BackgroundPostoperative complications contribute to morbidity and mortality. This study assessed the impact of surgical complications on healthcare resource utilization for patients undergoing elective colorectal procedures.MethodData were obtained on 530 consecutive colorectal operations performed from January 2010 to January 2011. Patient demographics, type of procedure, surgical complications classified as Clavien 1–5, length of stay, 60-day readmission rate, and hospital costs were recorded.ResultsSeventy-five percent of the operations were associated with malignancy, and 26% were pelvic procedures. Thirty-five percent of the patients developed at least one complication, 21% of the complications did not require intervention. The readmission rate was 7.4%. Nine patients died during 60-day post discharge follow up.Median length of stay was 9 (3–34) days in uncomplicated and 16 (4–205) days in complicated cases. Occurrence of any complication at index admission increased total hospital costs 2.1-fold (EUR 25,680 vs. EUR 12,405), with the largest cost differential attributed to wound dehiscence and/or suture line failure requiring reoperation. These increases were primarily due to prolonged hospitalization and ICU expenditures. Readmission resulted in a further increase to an average cost of EUR 12,585 per re-admitted patient.Multivariate analysis showed that BMI > 25, obesity, operation complexity and surgeon significantly affected the risk for complication. Also, hospital costs were significantly increased by any postoperative complications, reoperations, high complexity of surgical procedures and high comorbidity index.ConclusionsReducing morbidity after colorectal procedures improves quality of care and patient safety, and may also substantially reduce hospital costs and increase the efficiency of resource utilization.

Unplanned Reoperation Following Colorectal Surgery: Indications and Operations

“…Previous studies have found reoperation rates after colorectal resections to be higher than other general surgery procedures [1, 2, 7]. As patient outcomes and physician reimbursement are significantly impacted by reoperation rates, knowledge regarding indications for reoperation and reoperative procedures performed could provide valuable insight.…”

Wound dehiscence in a sample of 1 776 cystectomies: identification of predictors and implications for outcomes

“…In comparison, only 175 patients (10.2%) without wound dehiscence had a wound infection. Wound dehiscence occurred after a median (IQR) of 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) days and patients with wound dehiscence had a significantly higher rate of reinterventions (93% vs 6%, P < 0.001), pLOS (>11 days, 86% vs 26%; P < 0.001) and pOT (>411 min, 39% vs 25%; P = 0.03). However, the overall mortality (2.1%) and total postoperative readmission rates (6.4%) did not significantly differ ( Table 2).…”

Hospital costs of complications after a pancreatoduodenectomy

“…[1][2][3] Post-operative complications also substantially increase the use of additional resources per patient and prolong the hospital stay, raising medical costs even further. [4][5][6][7][8] A pancreatoduodenectomy (PD) is a typical example of a complex, highly specialised surgical procedure. Despite a reduction in the mortality of PD below 5% in high-volume centres, a PD is still accompanied with a substantial morbidity and post-operative complication rates are varying between 40 and 60%.…”