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Postoperative complications and hospital costs following small bowel resection surgery.
Lee, Dong-Kyu; Frye, Ashlee; Louis, Maleck; Koshy, Anoop Ninan; Tosif, Shervin; Yii, Matthew; Ma, Ronald; Nikfarjam, Mehrdad; Perini, Marcos Vinicius; Bellomo, Rinaldo; Weinberg, Laurence.
Afiliación
  • Lee DK; Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
  • Frye A; Department of Anesthesia, Austin Health, Heidelberg, Australia.
  • Louis M; Department of Anesthesia, Austin Health, Heidelberg, Australia.
  • Koshy AN; Department of Cardiology, Austin Health, Heidelberg, Australia.
  • Tosif S; Department of Anesthesia, Austin Health, Heidelberg, Australia.
  • Yii M; Department of Anesthesia, Austin Health, Heidelberg, Australia.
  • Ma R; Business Intelligence Unit, Austin Health, Heidelberg, Australia.
  • Nikfarjam M; Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Australia.
  • Perini MV; Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Australia.
  • Bellomo R; Department of Intensive Care, Austin Health, Heidelberg, Australia.
  • Weinberg L; Data Analytics Research & Evaluation (DARE) Centre, Austin Hospital and The University of Melbourne, Melbourne, Victoria, Australia.
PLoS One ; 15(10): e0241020, 2020.
Article en En | MEDLINE | ID: mdl-33085700
ABSTRACT

BACKGROUND:

Postoperative complications after major gastrointestinal surgery are a major contributor to hospital costs. Thus, reducing postoperative complications is a key target for cost-containment strategies. We aimed to evaluate the relationship between postoperative complications and hospital costs following small bowel resection.

METHODS:

Postoperative complications were recorded for 284 adult patients undergoing major small bowel resection surgery between January 2013 and June 2018. Complications were defined and graded according to the Clavien-Dindo classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology; it was reported in US dollars at 2019 rates. Regression modeling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs.

FINDINGS:

The overall complication prevalence was 81.6% (95% CI 85.7-77.5). Most complications (69%) were minor, but 22.9% of patients developed a severe complication (Clavien-Dindo grades III or IV). The unadjusted median total hospital cost for patients with any complication was 70% higher than patients without complications (median [IQR] USD 19,659.64 [13,545.81-35,407.14] vs. 11,551.88 [8,849.46-15,329.87], P < 0.001). The development of 1, 2, 3, and ≥ 4 complications increased hospital costs by 11%, 41%, 50%, and 195%, respectively. Similarly, more severe complications incurred higher hospital costs (P < 0.001). After adjustments were made (for the Charlson Comorbidity Index, anemia, surgical urgency and technique, intraoperative fluid administration, blood transfusion, and hospital readmissions), a greater number and increased severity of complications were associated with a higher adjusted median hospital cost. Patients who experienced complications had an adjusted additional median cost of USD 4,187.10 (95% CI 1,264.89-7,109.31, P = 0.005) compared to those without complications.

CONCLUSIONS:

Postoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following small bowel resection surgery and quantify their associated increase in hospital costs. TRIAL REGISTRATION Australian Clinical Trials Registration number 12620000322932.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Procedimientos Quirúrgicos del Sistema Digestivo / Costos de Hospital / Intestino Delgado Tipo de estudio: Etiology_studies / Health_economic_evaluation / Observational_studies / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Oceania Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2020 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Procedimientos Quirúrgicos del Sistema Digestivo / Costos de Hospital / Intestino Delgado Tipo de estudio: Etiology_studies / Health_economic_evaluation / Observational_studies / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Oceania Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2020 Tipo del documento: Article