Smoking Status and Health Care Costs in the Perioperative Period

Abstract

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.

Does smoking status affect cost of hospitalization? Evidence from three main diseases associated with smoking in Iran

“…This study found that the total cost of hospitalization for the current and former smoker categories were respectively 65% and 26% higher in unadjusted model and 35% and 24% in the adjusted model higher than for the never smoker category of patients. These findings are in line with other studies that have reported increased costs in current and former smoker patients compared to never smokers ( 2 , 11 , 14 , 15 , 22 ). A study in Germany reported a positive association between history of smoking, and direct and indirect costs.…”

“…The monthly cost of hospitalization for current smokers was $400 higher than the costs for never smokers. However, the cost for former smokers was $273 higher than the costs for never smokers ( 14 ). In our study, the difference in cost of hospitalization between current and never smokers was 17.9 million IR, whereas the difference between former smokers and never smokers was 7.2 million IR.…”

Pulmonary function in women: comparative analysis of conventional versus single-port laparoscopic cholecystectomy

“…Therefore, we cannot conclude that the presence of respiratory diseases interfered with the spirometric results, since the number of patients submitted to the test who presented respiratory diseases was too small and insufficient for an accurate statement. associated with a decrease in the secretion transport, an increase in mucus secretion, and in airway narrowing [26][27][28] .…”

Perioperative tobacco use treatments: putting them into practice

“…Increasing relative priority to provide treatment (IIID3) can be challenging in the face of the many other competing priorities. Discussion of evidence that smokers incur additional expenses compared with non-smokers can be used to bolster economic arguments, 17 as can the fact that tobacco treatment is among the most cost effective medical interventions available. [100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115] Outer setting factors that provide incentives to treat should also be identified and invoked.…”

“…It will discuss the prevalence and consequences of perioperative smoking; the principles of tobacco use treatment; the benefits of treating tobacco use in the surgical patient; the current state of implementation of tobacco treatment in clinical practice, including never smokers, current smokers incurred $400 (95% confidence interval $131 to $669) monthly additional medical costs over the first year after surgery. 17 When extrapolated to the US population, smoking results in approximately $10bn (£7.8bn; €8.8bn) annual excess postoperative costs. The risks of smoking extend beyond the smoker to people exposed to secondhand smoke; children and adults undergoing surgery who are exposed preoperatively to secondhand smoke have an increased risk of respiratory complications.…”