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Elective colectomy financial and opportunity cost analysis: diagnosis, case type, diversion, and complications

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Summary

Background

The purpose of this study was to financially profile four different types of elective colectomy resection in relation to diagnosis and complications.

Methods

A total of 1420 colectomies from three centers within our system were analyzed for diagnostic, complications, financial, length of stay (LOS), and case mix index (CMI) data for four procedure categories: colectomy above peritoneal reflection (AR) with diversion, colectomy AR without diversion, colectomy below peritoneal reflection (BR) with diversion, and colectomy BR without diversion. The incidence of complications and costs were compared between procedure groups. Logit models were used for probabilities of complications and Poisson for rate analysis.

Results

Elective colectomies AR were performed 72% of the time for non-inflammatory diagnoses (benign tumors, polyps, rectal prolapse, malignant tumors), whereas resections BR were performed 64% of the time for inflammatory diagnoses (diverticulitis, Crohn’s, ulcerative colitis, perforation, obstruction, sepsis, fistulae). Thus, diversion was performed in a higher proportion of cases with inflammatory diagnoses and cases requiring diversion had higher complication rates in both AR (16% vs. 5%) and BR (19% vs. 6%) resections.

Conclusion

Inflammatory diagnoses appear to drive the indication for diversion following elective colectomy. Colectomies with diversion have complication rates 1.36 times higher than without diversion, as well as excess LOS and costs. Resections AR with diversion had more than twice the proportion of complications as without diversion. Preoperative mitigation of inflammatory risk factors may decrease the rate of diversion and reduce complications, financial risk, and opportunity cost.

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Authors and Affiliations

  1. Northwell Health, 2000 Marcus Avenue, 11030, Manhasset, NY, USA

    Anthony C. Antonacci MD, SM, Katherine Carsky MD, Samuel P. Dechario, Gregg Husk MD, Dana Caulfield BS, MBA, David Allinger BA, MBA, Gene Coppa MD & Mark Jarrett MD, MBA, MS

  2. Tulane School of Medicine, 1430 Tulane Ave, 70112, New Orleans, LA, USA

    Christopher L. Antonacci BA

  3. 340 East 93rd Street, 18i, 10128, New York, NY, USA

    Anthony C. Antonacci MD, SM

Authors
  1. Anthony C. Antonacci MD, SM
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  2. Christopher L. Antonacci BA
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  3. Katherine Carsky MD
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  4. Samuel P. Dechario
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  5. Gregg Husk MD
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  6. Dana Caulfield BS, MBA
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  7. David Allinger BA, MBA
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  8. Gene Coppa MD
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  9. Mark Jarrett MD, MBA, MS
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Contributions

A. A. conceived of the original idea; A. A., G. H., and S. D. designed the database and implemented the data acquisition model; A. A., C. L. A., and S. D. performed the analytic calculations; D. C. and D. A. provided financial data; A. A., C. L. A., K. C., G. H., G. C., and M. J. contributed to the final version of the manuscript; all authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to Anthony C. Antonacci MD, SM.

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Conflict of interest

A.C. Antonacci, C.L. Antonacci, K. Carsky, S.P. Dechario, G. Husk, D. Caulfield, D. Allinger, G. Coppa, and M. Jarrett declare that they have no competing interests.

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Antonacci, A.C., Antonacci, C.L., Carsky, K. et al. Elective colectomy financial and opportunity cost analysis: diagnosis, case type, diversion, and complications. Eur Surg 54, 104–112 (2022). https://doi.org/10.1007/s10353-021-00716-w

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  • DOI: https://doi.org/10.1007/s10353-021-00716-w

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