The financial burden of complications following rectal resection

Abstract

To investigate the costs associated with postoperative complications following rectal resection. Rectal resection is a major surgical procedure that carries a significant risk of complications. The occurrence of complications following surgery has both health and financial consequences. There are very few studies that examine the incidence and severity of complications and their financial implications following rectal resection. We identified 381 consecutive patients who underwent a rectal resection within a major university hospital. Patients were included using the International Classification of Diseases (ICD) codes. Complications in the postoperative period were reported using the validated Clavien-Dindo classification system. Both the number and severity of complications were recorded. Activity-based costing methodology was used to report financial outcomes. Preoperative results were also recorded and assessed. A 76.9% [95% CI: 68.3:86.2] of patients experienced one or more complications. Patients who had a complication had a median total cost of $22,567 [IQR 16,607:33,641]. Patients who did not have a complication had a median total cost of $15,882 [IQR 12,971:19,861]. The adjusted additional median cost for patients who had a complication was $5308 [95% CI: 2938:7678] ( P < .001). Patients who experienced a complication tended to undergo an open procedure ( P = .001), were emergent patients ( P = .003), preoperatively had lower albumin levels (36 vs 38, P = .0003) and were anemic ( P = .001). Complications following rectal resection are common and are associated with increased costs. Our study highlights the importance of evaluating and preventing complications in the postoperative period.

The Association of Postoperative Complications and Hospital Costs Following Distal Pancreatectomy

“…From our data, we suggest that hospital costs are primarily driven by major complications rather than the number of complications following DP. This correlation between major complications (CVD grade ≥III) and additional financial burden is consistent with findings from several other studies analysing costs associated with post-abdominal surgery complications ( 12 , 14 , 23 ). However, these studies also found a significant association between the cumulative number of complications and pro-rata cost increases, in contrast to the findings of our study which did not demonstrate a statistically significant link.…”

A Randomized, Multicenter, Open-Label, Blinded End Point, Phase 2, Feasibility, Efficacy, and Safety Trial of Preoperative Microvascular Protection in Patients Undergoing Major Abdominal Surgery

“…We selected 3 types of major abdominal surgery associated with significant perioperative stress response a priori, namely, pancreas, colorectal, and liver resection surgeries. [17][18][19] We included adult patients (≥18 years of age) requiring arterial cannulation for continuous hemodynamic monitoring, with an expected hospital stay of at least 1 postoperative night. Exclusion criteria were an American Society of Anesthesiologists (ASA) physical status score of V, pregnancy or breastfeeding, poorly controlled diabetes mellitus (hemoglobin A1c >9.0% or hemoglobin A1c >75 mmol•mol −1 ), allergy to albumin or dexamethasone, chronic steroid use defined as prednisolone 10 mg per day or equivalent for greater than 1 week in the preceding 3 months, immunosuppressive drugs, and any surgical procedure within the preceding 2 months or expected within the subsequent 30 days.…”

Organ and function preservation in gastrointestinal cancer: Current and future perspectives on endoscopic ablation

“…This difference is at least in part due to the lack of unanimous commensurate improvement in overall survival with the improvement in complete histopathologic resection rates in pancreaticobiliary cancers. Furthermore, post-operative complications are significant considerations even when curative resections are achieved[ 21 , 22 ].…”