Failure of efforts to contain costs of care after colorectal procedures: Nationwide trends in length of stay, costs and post-acute care utilization.

BACKGROUND: This study aims to report trends in healthcare resource utilization and costs after colorectal surgery in the US. METHODS: From all-payer inpatient data, patients who were discharged after elective colorectal procedures (2002-2011) were identified. Trends in postoperative hospital stay, costs and post-acute care were evaluated. RESULTS: Of 251,583 included patients, median length of stay was 6 days. Trends over time suggested a progressive reduction in hospital stay after surgery until 2008 after which there was an increase (6.6 days in 2002, 5.9 days in 2008 and 6.1 days in 2010). Costs (peak:2011, $51,731) and post-acute care (peak:2011, 19.4%) continued to increase throughout. CONCLUSIONS: While length of stay over the last decade reduced, a further reduction may not be feasible. Meanwhile, inpatient costs as well as the use of post-acute care programs have continued to rise. Healthcare planning needs to focus on patients who cannot be discharged early, and more comprehensively evaluate the interplay between length of stay, readmissions, inpatient and post-acute care utilization if we are to contain overall healthcare costs.