Rethinking Priorities: Cost of Complications After Elective Colectomy

Cheryl K. Zogg, Peter Najjar, Arturo J Rios Diaz, Donald L. Zogg, Thomas C. Tsai, John A. Rose, John W. Scott, Faiz Gani, Husain Alshaikh, Neeraja Nagarajan, Joseph K. Canner, Eric B. Schneider, Joel E. Goldberg, Adil H. Haider

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses. SUMMARY BACKGROUND DATA:: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking. METHODS:: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared. RESULTS:: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3% was due to complications [1.9% due to current Centers for Medicare and Medicaid Services (CMS) complications]. CONCLUSIONS:: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Oct 22 2015

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Colectomy
Costs and Cost Analysis
Colonic Neoplasms
Centers for Medicare and Medicaid Services (U.S.)
Hospital Costs
Quality Improvement
Ulcerative Colitis
Crohn Disease
Health Care Costs
Inpatients
Lung
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Zogg, C. K., Najjar, P., Diaz, A. J. R., Zogg, D. L., Tsai, T. C., Rose, J. A., ... Haider, A. H. (Accepted/In press). Rethinking Priorities: Cost of Complications After Elective Colectomy. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001511

Rethinking Priorities : Cost of Complications After Elective Colectomy. / Zogg, Cheryl K.; Najjar, Peter; Diaz, Arturo J Rios; Zogg, Donald L.; Tsai, Thomas C.; Rose, John A.; Scott, John W.; Gani, Faiz; Alshaikh, Husain; Nagarajan, Neeraja; Canner, Joseph K.; Schneider, Eric B.; Goldberg, Joel E.; Haider, Adil H.

In: Annals of Surgery, 22.10.2015.

Research output: Contribution to journalArticle

Zogg, CK, Najjar, P, Diaz, AJR, Zogg, DL, Tsai, TC, Rose, JA, Scott, JW, Gani, F, Alshaikh, H, Nagarajan, N, Canner, JK, Schneider, EB, Goldberg, JE & Haider, AH 2015, 'Rethinking Priorities: Cost of Complications After Elective Colectomy', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001511
Zogg, Cheryl K. ; Najjar, Peter ; Diaz, Arturo J Rios ; Zogg, Donald L. ; Tsai, Thomas C. ; Rose, John A. ; Scott, John W. ; Gani, Faiz ; Alshaikh, Husain ; Nagarajan, Neeraja ; Canner, Joseph K. ; Schneider, Eric B. ; Goldberg, Joel E. ; Haider, Adil H. / Rethinking Priorities : Cost of Complications After Elective Colectomy. In: Annals of Surgery. 2015.
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abstract = "OBJECTIVE:: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses. SUMMARY BACKGROUND DATA:: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking. METHODS:: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared. RESULTS:: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4{\%} experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3{\%} was due to complications [1.9{\%} due to current Centers for Medicare and Medicaid Services (CMS) complications]. CONCLUSIONS:: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.",
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T2 - Cost of Complications After Elective Colectomy

AU - Zogg, Cheryl K.

AU - Najjar, Peter

AU - Diaz, Arturo J Rios

AU - Zogg, Donald L.

AU - Tsai, Thomas C.

AU - Rose, John A.

AU - Scott, John W.

AU - Gani, Faiz

AU - Alshaikh, Husain

AU - Nagarajan, Neeraja

AU - Canner, Joseph K.

AU - Schneider, Eric B.

AU - Goldberg, Joel E.

AU - Haider, Adil H.

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N2 - OBJECTIVE:: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses. SUMMARY BACKGROUND DATA:: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking. METHODS:: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared. RESULTS:: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3% was due to complications [1.9% due to current Centers for Medicare and Medicaid Services (CMS) complications]. CONCLUSIONS:: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.

AB - OBJECTIVE:: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses. SUMMARY BACKGROUND DATA:: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking. METHODS:: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared. RESULTS:: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3% was due to complications [1.9% due to current Centers for Medicare and Medicaid Services (CMS) complications]. CONCLUSIONS:: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.

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