The impact of complications on costs of major surgical procedures: A cost analysis of 1200 patients

René Vonlanthen, Ksenija Slankamenac, Stefan Breitenstein, Milo A. Puhan, Markus K. Muller, Dieter Hahnloser, Dimitri Hauri, Rolf Graf, Pierre Alain Clavien

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Abstract

OBJECTIVE:: To assess the impact of postoperative complications on full in-hospital costs per case. BACKGROUND:: Rising expenses for complex medical procedures combined with constrained resources represent a major challenge. The severity of postoperative complications reflects surgical outcomes. The magnitude of the cost created by negative outcomes is unclear. PATIENTS AND METHODS: Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary, high-volume center was assessed by a validated, complication score system. Full in-hospital costs were collected for each patient. Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders. RESULTS:: This study population included 393 complex liver/bile duct surgeries, 110 major pancreas operations, 389 colon resections, and 308 Roux-en-Y gastric bypasses. The overall 30-day mortality rate was 1.8%, whereas morbidity was 53.8%. Patients with an uneventful course had mean costs per case of US$ 27,946 (SD US$ 15,106). Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 (SD US$ 151,191) for grade IV complications. This increase in costs, up to 5 times the cost of a similar operation without complications, was observed for all types of investigated procedures, although the magnitude of the increase varied, with the highest costs in patients undergoing pancreas surgery. CONCLUSION:: This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs. Furthermore, the study highlights a relevant savings capacity for major surgical procedures, and supports all efforts to lower negative events in the postoperative course. Copyright C

Original languageEnglish (US)
Pages (from-to)907-913
Number of pages7
JournalAnnals of Surgery
Volume254
Issue number6
DOIs
StatePublished - Dec 2011

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ASJC Scopus subject areas

  • Surgery

Cite this

Vonlanthen, R., Slankamenac, K., Breitenstein, S., Puhan, M. A., Muller, M. K., Hahnloser, D., Hauri, D., Graf, R., & Clavien, P. A. (2011). The impact of complications on costs of major surgical procedures: A cost analysis of 1200 patients. Annals of Surgery, 254(6), 907-913. https://doi.org/10.1097/SLA.0b013e31821d4a43