Patient comorbidities increase postoperative resource utilization after laparoscopic and open cholecystectomy
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An understanding of the relationship between patient factors and healthcare resource utilization represents a major point of interest for optimizing clinical care and overall net savings, yet maintaining financial margins for provider revenues. This study aims to review resource utilization after cholecystectomy in order to characterize patient factors associated with increased postoperative ED visits and 30-day readmissions.
A total of 53,632 open and laparoscopic cholecystectomies were reviewed from July 2009 to December 2010 in a large private payer claims database. ICD-9 and CPT codes were available for each event, as well as basic demographics. Data regarding 30-day postoperative resource utilization metrics (emergency department visits and inpatient hospitalizations) were analyzed and stratified by key patient comorbidities. Differences between subgroups were evaluated with univariate and multivariable methods.
Of the 53,632 patients studied, 71.2 % (38,171) were female and 28.8 % (15,461) male. Resource utilization within 30 days of surgery included: 6.6 % (3538) of patients with an ED visit and 7.7 % (4103) with an inpatient hospitalization. The most common comorbidities in the study population were: hypertension, hyperlipidemia, GERD/hiatal hernia, and diabetes mellitus. Patients with heart failure, cirrhosis, and a history of MI or acute ischemic heart disease all had a significant association with postoperative ED visit and the highest likelihood of inpatient hospitalization. Angina, diabetes, and hypertension similarly increased both ED utilization and inpatient readmissions to a lesser but still significant extent. Although patients with GERD/hiatal hernia and sleep apnea had a significant association with ED use, they did not have an increased likelihood of readmission.
Patient comorbidity indexing plays a major role in clinical risk stratification and resource utilization for cholecystectomy. These factors should be considered in bundled reimbursement packages and in the creation of preventive postoperative ambulatory strategies given their role in determining potential resource utilization in the postoperative setting.
KeywordsCholecystectomy Resource utilization Comorbidities Risk stratification Bundled payments Reimbursement packages Affordable Care Act
This work was supported by an unrestricted Grant from Ethicon Endosurgery.
Compliance with ethical standards
Jacqueline Boehme and Sophia McKinley have no conflict of interest or financial ties to disclose. Michael Brunt receives institutional research support from Gore and Karl Storz Endoscopy. Tina Hunter is a Senior Director for Biostatistics and Health Outcomes Research at CTI Clinical Trials and Consulting. Daniel Jones receives support from Allurion, Intuitive Surgical, Uptodate, CineMed, and Wolters. Daniel Scott, MD receives support from Ethicon, Covidien, Karl Storz, Accelerated Technologies, Inc., and NeatStitch, Inc. Steven Schwaitzberg, MD receives support from Acuity Bio (ownership interest as advisory committee), Cambridge Endo (ownership interest as advisory committee), Endocore (consulting fee as independent contractor), Human Extensions (honoraria as consultant), Neatstitch (ownership interest as advisory committee), Olympus (consulting fee as consultant), Stryker (consulting fee as consultant), and Surgiquest (ownership interest as advisory committee).
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