Incremental cost of complications in colectomy: a warranty guided approach to surgical quality improvement

Financial burden of postoperative complications following colonic resection

“…The additional costs of complications varied from €1478.63 [$2290] [ 14 ] to $39,306 [$43,146], [ 21 ] this is in part due to the heterogenous definitions of hospital costs adopted by the different studies as well as the different complication types reported. Asgeirsson et al [ 11 ] and Knechtle et al [ 25 ] further demonstrate a positive correlation between the count of complications and the additional cost incurred by the hospital. All studies reporting hospital charges and hospital reimbursements demonstrated a positive increase in hospital resource utilization with postoperative complications (Table S2, Supplemental Digital Content).…”

“…Asgeirsson et al [ 11 ] demonstrated an increase in the additional cost of SSI from $22,730 [$24,563] for superficial SSIs to $30,733 [$33,211] for deep SSIs. Fukuda et al, [ 18 ] demonstrated similar increases in hospital charges with increasing SSI severity.…”

“…This significant variation in costs for SSI can be attributed to the geographic differences in health care systems. Asgeirsson et al [ 11 ] was the only study directly comparing SSI with postoperative ileus demonstrating significantly higher additional costs in the presence of SSI than with postoperative ileus (Table 1 ).…”

“…Nine studies [ 11 , 13 , 14 , 18 , 19 , 22 , 30 , 37 , 40 ] reported the cost of complications in open and laparoscopic surgery, however only one study [ 37 ] compared the two groups as its primary outcome. Postoperative complications in open surgery were shown to be associated with higher hospital costs than postoperative complications in laparoscopic surgery across all included studies except Kashimura et al [ 22 ] (Table S3, Supplemental Digital Content).…”

“…In addition, the incidence of complications was consistently higher in open surgery as compared to laparoscopic surgery in all studies, but only reached statistical significance in six studies. [ 11 , 18 , 24 , 37 , 38 , 40 ] The risk of selection bias due to the retrospective nature of the studies and existence of uncertainty around the statistical significance of data reported in some studies means that these findings are supported by weak evidence.…”