Dataset Information

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study.

ABSTRACT:

Objectives

To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy.

Methods

Postoperative 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.

Results

135 (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.

Conclusions

These 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 registration

Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN:12622000057785.

SUBMITTER: Weinberg L

PROVIDER: S-EPMC9956632 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study.

Weinberg Laurence L Aitken Sarah Aishah Azlina SAA Kaldas Peter P Fletcher Luke L Lloyd-Donald Patryck P Le Peter P Do Daniel D Caruana Carla Borg CB Walpole Dominic D Ischia Joseph J Ma Ronald R Tan Chong Oon CO Lee Dong-Kyu DK

PloS one 20230224 2

<h4>Objectives</h4>To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy.<h4>Methods</h4>Postoperative 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-hos ...[more]

PMID: 36827411

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Project description:BackgroundPostoperative 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.MethodsPostoperative 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.FindingsThe 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.ConclusionsPostoperative 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 registrationAustralian Clinical Trials Registration number: 12620000322932.

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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:BackgroundOpen radical cystectomy (ORC) and urinary diversion in patients with bladder cancer (BCa) are associated with significant perioperative complication risk.ObjectiveTo compare perioperative complications between robot-assisted radical cystectomy (RARC) and ORC techniques.Design, setting, and participantsA prospective randomized controlled trial was conducted during 2010 and 2013 in BCa patients scheduled for definitive treatment by radical cystectomy (RC), pelvic lymph node dissection (PLND), and urinary diversion. Patients were randomized to ORC/PLND or RARC/PLND, both with open urinary diversion. Patients were followed for 90 d postoperatively.InterventionStandard ORC or RARC with PLND; all urinary diversions were performed via an open approach.Outcome measurements and statistical analysisPrimary outcomes were overall 90-d grade 2-5 complications defined by a modified Clavien system. Secondary outcomes included comparison of high-grade complications, estimated blood loss, operative time, pathologic outcomes, 3- and 6-mo patient-reported quality-of-life (QOL) outcomes, and total operative room and inpatient costs. Differences in binary outcomes were assessed with the chi-square test, with differences in continuous outcomes assessed by analysis of covariance with randomization group as covariate and, for QOL end points, baseline score.Results and limitationsThe trial enrolled 124 patients, of whom 118 were randomized and underwent RC/PLND. Sixty were randomized to RARC and 58 to ORC. At 90 d, grade 2-5 complications were observed in 62% and 66% of RARC and ORC patients, respectively (95% confidence interval for difference, -21% to -13%; p=0.7). The similar rates of grade 2-5 complications at our mandated interim analysis met futility criteria; thus, early closure of the trial occurred. The RARC group had lower mean intraoperative blood loss (p=0.027) but significantly longer operative time than the ORC group (p<0.001). Pathologic variables including positive surgical margins and lymph node yields were similar. Mean hospital stay was 8 d in both arms (standard deviation, 3 and 5 d, respectively; p=0.5). Three- and 6-mo QOL outcomes were similar between arms. Cost analysis demonstrated an advantage to ORC compared with RARC. A limitation is the setting at a single high-volume, referral center; our findings may not be generalizable to all settings.ConclusionsThis trial failed to identify a large advantage for robot-assisted techniques over standard open surgery for patients undergoing RC/PLND and urinary diversion. Similar 90-d complication rates, hospital stay, pathologic outcomes, and 3- and 6-mo QOL outcomes were observed regardless of surgical technique.Patient summaryOf 118 patients with bladder cancer who underwent radical cystectomy, pelvic lymph node dissection, and urinary diversion, half were randomized to open surgery and half to robot-assisted laparoscopic surgery. We compared the rate of complications within 90 d after surgery for the open group versus the robotic group and found no significant difference between the two groups.Trial registrationClinicalTrials.gov identifier NCT01076387, www.clinicaltrials.gov.

Dataset Information

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study.

Objectives

Methods

Results

Conclusions

Trial registration

Publications

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study.

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