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Postoperative complications and hospital costs following small bowel resection surgery.

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.

SUBMITTER: Lee DK

PROVIDER: S-EPMC7577438 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Postoperative complications and hospital costs following small bowel resection surgery.

Lee Dong-Kyu DK Frye Ashlee A Louis Maleck M Koshy Anoop Ninan AN Tosif Shervin S Yii Matthew M Ma Ronald R Nikfarjam Mehrdad M Perini Marcos Vinicius MV Bellomo Rinaldo R Weinberg Laurence L

PloS one 20201021 10

<h4>Background</h4>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.<h4>Methods</h4>Postoperative complications were recorded for 284 adult patients undergoing major small bowel resection surgery between January 2013 and Jun ...[more]

PMID: 33085700

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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: 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:ObjectivesTo evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy.MethodsPostoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien-Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model.Results135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9-53,532.5) and $81,050.1 (49,614.8-122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%-76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%-181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08-1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23-5.07) respectively.ConclusionsThese findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies.Trial registrationTrial Registration: Australian New Zealand Clinical Trials Registry (ACTRN:12622000057785.

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

Project description:BackgroundSince postoperative pulmonary complications are one of the main causes of morbidity and mortality in patients undergoing lung resection surgery, we performed a meta-analysis to compare the incidence of postoperative pulmonary complications and hospital death, and the length of hospital stay in patients who received nonintubated or intubated anesthesia during thoracoscopic surgery for lung resection and further explore the tricks in nonintubated anesthesia.MethodsPubMed, Embase, and Cochrane Library were searched from inception to September 2017. We included eligible research comparing nonintubated anesthesia with intubated anesthesia in thoracoscopic surgery for lung resection. The primary outcomes involved postoperative pulmonary complications, hospital death, and hospital stay. The rates and causes of conversion from nonintubated anesthesia to intubated anesthesia were also analyzed.ResultsAfter screening through 754 potentially relevant articles, we included 3 randomized controlled trials and 7 observational studies with 1138 patients. There was no perioperative mortality in 2 groups. The nonintubated group revealed comparable postoperative pulmonary complications (OR?=?0.57; P?=?.07; P for heterogeneity?=?.49, I?=?0%) and shorter hospital stay (WMD?=?-1.10; P?<?.00001; P for heterogeneity?=?.84, I?=?0%) in overall findings with little heterogeneity.ConclusionNonintubated anesthesia in thoracoscopic surgery for lung resection shortened the length of hospital stay compared with intubated anesthesia. However, the incidence of postoperative pulmonary complications was comparable between nonintubated and intubated group. Given the potential perioperative emergencies, such as persistent hypoxemia, carbon dioxide retention, or extensive pleural adhesions, nonintubated anesthesia in lung resection surgery requires extra vigilance to ensure the safety of the patients and the success of the surgery. Powerful randomized controlled trials in the future are essential to provide more certainty and address long-term effectiveness. Only when anesthesiologists and surgeons make efforts together can better clinical outcomes in lung resection surgery be achieved.

Project description:ImportanceAdhesion-related complications (ARCs), including small-bowel obstruction, are common complications of intra-abdominal surgery. Statins, which have antifibrotic pleiotropic effects, inhibit adhesion formation in murine models but have not been assessed in humans.ObjectiveTo assess whether statin use at the time of intra-abdominal surgery is associated with a reduction in ARCs.Design, setting, and participantsThese 2 separate retrospective cohort studies (The Health Improvement Network [THIN] and Optum's Clinformatics Data Mart [Optum]) compared adults receiving statins with those not receiving statins at the time of intra-abdominal surgery. Individuals undergoing intra-abdominal surgery from January 1, 1996, to December 31, 2013, in the United Kingdom and from January 1, 2000, to December 31, 2016, in the US were included in the study. Those with obstructive events before surgery or a history of inflammatory bowel disease were excluded. Data analysis was performed from September 1, 2012, to November 24, 2020.ExposureThe primary exposure was statin use at the time of surgery.Main outcomes and measuresThe primary outcome was ARCs, defined as small-bowel obstruction or need for adhesiolysis, occurring after surgery. Sensitivity analyses included statin use preceding but not concurrent with surgery, fibrate use, and angiotensin-converting enzyme inhibitor use. All analyses were adjusted for age, sex, and conditions associated with microvascular disease, such as hypertension, hyperlipidemia, obesity, and tobacco use; surgical approach and site; and diagnosis of a malignant tumor.ResultsA total of 148 601 individuals met the inclusion criteria for THIN (mean [SD] age, 49.6 [17.7] years; 70.1% female) and 1 188 217 for Optum (mean [SD] age, 48.2 [16.4] years; 72.6% female). A total of 2060 participants (1.4%) experienced an ARC in THIN and 54 136 (4.6%) in Optum. Statin use at the time of surgery was associated with decreased risk of ARCs (THIN: adjusted hazard ratio [HR], 0.81; 95% CI, 0.71-0.92; Optum: adjusted HR, 0.92; 95% CI, 0.90-0.95). Similar associations were appreciated between statins and small-bowel obstruction (THIN: adjusted HR, 0.80; 95% CI, 0.70-0.92; Optum: adjusted HR, 0.88; 95% CI, 0.85-0.91).Conclusions and relevanceThis study's findings suggest that, among individuals in 2 separate cohorts undergoing intra-abdominal surgery, statin use may be associated with a reduced risk of postoperative ARCs. Statins may represent an inexpensive, well-tolerated pharmacologic option for preventing ARCs.

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Postoperative complications and hospital costs following small bowel resection surgery.

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Postoperative complications and hospital costs following small bowel resection surgery.

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