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A reduction in hospital length of stay reduces costs for colorectal surgery: an economic evaluation of the National Surgical Quality Improvement Program in Singapore

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

In 2017, the National Surgical Quality Improvement Program (NSQIP) was introduced in the Department of Colorectal Surgery at Singapore General Hospital as a pilot quality improvement initiative. This study aimed to examine the cost-effectiveness of NSQIP by evaluating its effects on surgical outcomes, length of stay (LOS), and costs.

Methods

We retrospectively reviewed patients undergoing colorectal surgery (2017–2020). Patients were divided into two cohorts: pre-NSQIP (2017–2018) and post-NSQIP (2019–2020). Outcomes evaluated were 30-day postoperative complications, LOS, and costs. Total cost-savings from NSQIP intervention’s impact on LOS were estimated using a decision model with a one-way sensitivity analysis. Multivariate logistic regression was performed to identify factors for prolonged LOS.

Results

1905 patients underwent colorectal surgery, with 996 in the pre-NSQIP cohort and 909 in the post-NSQIP cohort. A significant reduction in overall postoperative complications of 4.7% was observed in the post-NSQIP cohort (36.5% vs. 31.8%, p = 0.029). Patients in the post-NSQIP cohort had a shorter median LOS (8.0 vs. 6.0 days, p < 0.001). The implementation of NSQIP resulted in an 8.5% decrease in prolonged LOS > 6 days (p < 0.001), saving S$0.31 million on LOS. Total costs per case were reduced by 20.8% following NSQIP (S$39,539.05 vs. S$31,311.93, p < 0.001).

Conclusion

Implementing NSQIP has significantly reduced overall postoperative complications, LOS, and costs and achieved cost savings following colorectal surgery.

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Data availability

The data supporting this study’s findings are not publicly available due to privacy and ethical restrictions.

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Funding

No funds, grants, or other support were received.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore

    Emile John Kwong Wei Tan, Hui Lionel Raphael Chen, Aik Yong Chok & Yun Zhao

  2. Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore

    Ivan En-Howe Tan, Yun Zhao, Rachel Shiyi Lee & Marianne Kit Har Au

  3. Finance, Singapore General Hospital, Singapore, 169608, Singapore

    Kwok Ann Ang

  4. Finance, Singhealth Community Hospitals, Singapore, 168582, Singapore

    Marianne Kit Har Au

  5. Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, 169608, Singapore

    Hock Soo Ong

  6. Department of Urology, Singapore General Hospital, Singapore, 169608, Singapore

    Henry Sun Sien Ho

  7. Department of Anesthesiology, Singapore General Hospital, Singapore, 169608, Singapore

    Ruban Poopalalingam

  8. Singapore General Hospital, Singapore, 169608, Singapore

    Hiang Khoon Tan & Kenneth Yung Chiang Kwek

  9. SingHealth Duke-NUS Global Health Institute, Singapore, Singapore

    Hiang Khoon Tan

  10. Singapore Health Services, Singapore, 168582, Singapore

    Kenneth Yung Chiang Kwek

Authors
  1. Emile John Kwong Wei Tan
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  2. Hui Lionel Raphael Chen
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Contributions

Conceptualization: Emile John Kwong Wei Tan, Aik Yong Chok, Ivan En-Howe Tan. Methodology: Aik Yong Chok; Yun Zhao; Rachel Shiyi Lee. Software: Aik Yong Chok; Yun Zhao. Validation: Hui Lionel Raphael Chen; Aik Yong Chok; Ivan En-Howe Tan; Emile John Kwong Wei Tan; Kwok Ann Ang; Hock Soo Ong. Formal analysis: Yun Zhao; Rachel Shiyi Lee. Investigation: Emile John Kwong Wei Tan; Marianne Kit Har Au; Hock Soo Ong; Henry Sun Sien Ho. Resources: Marianne Kit Har Au; Hock Soo Ong; Henry Sun Sien Ho; Ruban Poopalalingam; Hiang Khoon Tan; Kenneth Yung Chiang Kwek. Data curation: Yun Zhao; Ivan En-Howe Tan; Marianne Kit Har Au. Writing – Original Draft: Emile John Kwong Wei Tan; Hui Lionel Raphael Chen; Aik Yong Chok; Yun Zhao; Ivan En-Howe Tan. Writing – Review & Editing: all authors. Visualization: Aik Yong Chok; Yun Zhao. Supervision: Marianne Kit Har Au; Hock Soo Ong; Henry Sun Sien Ho; Ruban Poopalalingam; Hiang Khoon Tan; Kenneth Yung Chiang Kwek. Project administration: Aik Yong Chok; Emile John Kwong Wei Tan; Kwok Ann Ang. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Emile John Kwong Wei Tan.

Ethics declarations

Ethics approval

This study was approved by Singapore Health Services (SingHealth) Institutional Review Board (Ref. 2022/2438) and reported in accordance with Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) guidelines. Due to the study's retrospective design using de-identified data, written informed consent collection was waived by SingHealth Centralised Institutional Review Board. All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki).

Competing interests

The authors declare no competing interests.

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Tan, E.J.K.W., Chen, H.L.R., Chok, A.Y. et al. A reduction in hospital length of stay reduces costs for colorectal surgery: an economic evaluation of the National Surgical Quality Improvement Program in Singapore. Int J Colorectal Dis 38, 257 (2023). https://doi.org/10.1007/s00384-023-04551-1

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