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The hospital costs of complications following colonic resection surgery: A retrospective cohort study.

ABSTRACT: Background:Colonic resection is a common surgical procedure associated with a high rate of postoperative complications. The aim of this observational study is to estimate the in-hospital costs of complications and to identify perioperative variables associated with complication development following colon resection surgery. Materials and methods:We conducted a single-centre cohort study with retrospective data collection of 487 patients undergoing colonic resection surgery between 2013 and 2018. Postoperative complications were graded according to the Clavien-Dindo classification system. In-hospital cost of index admission is reported in 2019 United States Dollars. Regression modelling was used to investigate the relationship of a priori selected perioperative variables and presence of complications and costs. Results:Overall complication prevalence was 69.6% (95%CI:65.5%-73.7%). Median [interquartile range] cost of patients with postoperative complications was significantly increased as compared to patients without complications ($17,963 [13,533:25,178] vs $12,578 [10,196:16,140]; p < 0.0001). Clavien-Dindo Grade I, II, III and IV complications increased costs by 15.8%, 36.8%, 169.4% and 240.1% respectively (p < 0.0001). Presence of complications was significantly associated with Charlson Comorbidity Index (Odds ratio (OR) per 1-unit increase: 1.09; 95%CI:1.02 to 1.17), preoperative albumin levels (OR per 1-unit increase: 0.94; 95%CI:0.90 to 0.98) and open as compared to laparoscopic resection (OR: 2.41; 95%CI:1.32 to 4.42). Conclusions:There is a high prevalence of complications following colonic resection surgery. Postoperative complications, including minor complications (Clavien-Dindo Grade I-II), were associated with a significant increase in hospital costs and are a key target for cost containment strategies.

SUBMITTER: Louis M

PROVIDER: S-EPMC7190696 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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The hospital costs of complications following colonic resection surgery: A retrospective cohort study.

Louis Maleck M Johnston Samuel A SA Churilov Leonid L Ma Ronald R Marhoon Nada N Burgess Adele A Christophi Chris C Weinberg Laurence L

Annals of medicine and surgery (2012) 20200419

<h4>Background</h4>Colonic resection is a common surgical procedure associated with a high rate of postoperative complications. The aim of this observational study is to estimate the in-hospital costs of complications and to identify perioperative variables associated with complication development following colon resection surgery.<h4>Materials and methods</h4>We conducted a single-centre cohort study with retrospective data collection of 487 patients undergoing colonic resection surgery between ...[more]

PMID: 32368338

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Project description:Interventions: Elective or emergent colonic resection, defined using the procedural ICD-10 codes: 32000-00 Limited excision of large intestine with formation of stoma 32000-01 Right hemicolectomy with formation of stoma 32000-02 Laparoscopic limited excision of large intestine with formation of stoma 32000-03 Laparoscopic right hemicolectomy with formation of stoma 32003-00 Limited excision of large intestine with anastomosis 32003-01 Right hemicolectomy with anastomosis 32003-02 Laparoscopic limited excision of large intestine with anastomosis 32003-03 Laparoscopic right hemicolectomy with anastomosis 32004-00 Subtotal colectomy with formation of stoma 32004-01 Extended right hemicolectomy with formation of stoma 32004-02 Laparoscopic subtotal colectomy with formation of stoma 32004-03 Laparoscopic extended right hemicolectomy with formation of stoma 32005-00 Subtotal colectomy with anastomosis 32005-01 Extended right hemicolectomy with anastomosis 32005-02 Laparoscopic subtotal colectomy with anastomosis 32005-03 Laparoscopic extended right hemicolectomy with anastomosis 32006-00 Left hemicolectomy with anastomosis 32006-01 Left hemicolectomy with formation of stoma 32006-02 Laparoscopic left hemicolectomy with anastomosis 32006-03 Laparoscopic left hemicolectomy with formation of stoma 32009-00 Total colectomy with ileostomy 32009-01 Laparoscopic total colectomy with ileostomy 32012-00 Total colectomy with ileorectal anastomosis 32012-01 Laparoscopic total colectomy with ileorectal anastomosis The procedures were performed at the Austin Hospital, a tertiary hospital with colorectal expertise, over the period of January 2013 and June 2018. Patients were followed-up for 30 days following discharge from the index admission. If no subsequent readmissions occurred within this period, follow-up ceased. If a patient was readmitted within the 30-day period, then the readmission was included, and followi Primary outcome(s): Costs of complications (as a composite outcome) following Colon resections. Costs of complications defined as cost of patients with complications less the cost of patients without complications (ie by comparison of patients with and without complications). All costs related to the index admission for colon resection and any consequent readmissions are included. Costs related to preoperative course are not considered. Allocation of costs will be calculated using an activity-based costing methodology. Only in-hospital costs are considered, with both direct and indirect costs assessed to produce a total cost for each patient. Costs for each patient will be obtained from the Austin Health Department of Finance, which maintain an itemised prospective database of all hospital expenses related to each patient.[Costs will be calculated from day of surgery to hospital discharge. Readmissions are considered within 30 days of discharge from the index admission.] Study Design: Purpose: Natural history;Duration: Longitudinal;Selection: Defined population;Timing: Retrospective

Project description:Interventions: There is no participant involvement. Only the de-identified hospital medical record of patients who have undergone surgery will be reviewed. We will review the following ICD Codes: 30515-03 Ileocolic resection with anastomosis 30515-04 Laparoscopic ileocolic resection with anastomosis 30515-05 Ileocolic resection with formation of stoma 30515-06 Laparoscopic ileocolic resection with formation of stoma 30565-00 Resection of small intestine with formation of stoma 30566-00 Resection of small intestine with anastomosis The procedures were performed at the Austin Hospital, a tertiary hospital with small bowel expertise, over the period of January 2013 and June 2018. Patients were followed-up for 30 days following discharge from the index admission. If no subsequent re-admissions occurred within this period, follow-up ceased. If a patient was readmitted within the 30-day period, then the readmission was included, and following discharge from the readmission or end of the original 30-day period, whichever was later, follow-up ceased. Primary outcome(s): Costs of complications as a composite outcome defined as cost of patients with complications less the cost of patients without complications (i.e. by comparison of patients with and without complications). All costs related to the index admission for small bowel resections and any consequent readmissions are included. Costs related to preoperative course are not considered. Allocation of costs will be done based on service volume, and costs calculated using an activity-based costing methodology. Only in-hospital costs are considered, with both direct and indirect costs assessed to produce a total cost for each patient. Costs for each patient will be obtained from the Austin Health Department of Finance, which maintain an itemised prospective database of all hospital expenses related to each patient.[Costs will be calculated from day of surgery to hospital discharge. Readmissions are considered within 30 days of discharge from the index admission.] Study Design: Purpose: Natural history;Duration: Longitudinal;Selection: Defined population;Timing: Retrospective

Project description:Interventions: ICD Codes that were included were: 32026-00 Ultra low anterior resection of rectum 32024-00 High anterior resection of rectum 32030-00 Rectosigmoidectomy with formation of stoma 32028-00 Ultra low anterior resection of rectum with hand sutured coloanal anastomosis 32030-01 Laparoscopic rectosigmoidectomy with formation of stoma 32051-00 Total proctocolectomy with ileo-anal anastomosis 32039-00 Abdominoperineal proctectomy 32025-00 Low anterior resection of rectum 92208-00 Anterior resection of rectum, level unspecified 32015-00 Total proctocolectomy with ileostomy 32051-01 Total proctocolectomy with ileo-anal anastomosis and formation of temporary ileostomy 32112-00 Perineal rectosigmoidectomy 32047-00 Perineal proctectomy The procedures were performed at the Austin Hospital, a tertiary hospital with colorectal expertise, over the period of January 2013 and June 2018. Patients were followed-up for 30 days following discharge from the index admission. If no subsequent readmissions occurred within this period, follow-up ceased. If a patient was readmitted within the 30-day period, then the readmission was included, and following discharge from the readmission or end of the original 30-day period, whichever was later, follow-up ceased. Primary outcome(s): Costs of complications as a composite outcome defined as cost of patients with complications less the cost of patients without complications (i.e. by comparison of patients with and without complications). All costs related to the index admission for rectal resection and any consequent readmissions are included. Costs related to preoperative course are not considered. Allocation of costs will be done based on service volume, and costs calculated using an activity-based costing methodology. Only in-hospital costs are considered, with both direct and indirect costs assessed to produce a total cost for each patient. Costs for each patient will be obtained from the Austin Health Department of Finance, which maintain an itemised prospective database of all hospital expenses related to each patient.[Costs will be calculated from day of surgery to hospital discharge. Readmissions are considered within 30 days of discharge from the index admission.] Study Design: Purpose: Natural history;Duration: Longitudinal;Selection: Defined population;Timing: Retrospective

Dataset Information

The hospital costs of complications following colonic resection surgery: A retrospective cohort study.

Publications

The hospital costs of complications following colonic resection surgery: A retrospective cohort study.

Similar Datasets

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