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Title: Postoperative complications and hospital costs following small bowel resection surgery.
Austin Authors: 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 
Affiliation: Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
Data Analytics Research and Evaluation (DARE) Centre
Business Intelligence Unit
Surgery (University of Melbourne)
Intensive Care
Issue Date: 2020 2020
Publication information: PLoS One 2020; 15(10): e0241020
Abstract: 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. 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. 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. 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. Australian Clinical Trials Registration number: 12620000322932.
DOI: 10.1371/journal.pone.0241020
ORCID: 0000-0001-7698-6302
PubMed URL: 33085700
Type: Journal Article
Appears in Collections:Journal articles

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