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The Cost of Complications Following Major Resection of Malignant Neoplasia

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Rising healthcare costs have led to increased focus on the need to achieve a higher “value of care.” As value-maximization efforts expand to include more complex surgical patients, evidence to support meaningful implementation of complication-based initiatives is lacking. The objective of this study was to compare incremental costs of complications following major gastrointestinal (GI) resections for organ-specific malignant neoplasia using nationally representative data.

Methods

National (Nationwide) Inpatient Sample data, 2001–2014, were queried for adult (≥ 18 years) patients undergoing major resections for malignant neoplasia. Based on system-based complications considered relevant to the long-term treatment of GI disease, stratified differences in risk-adjusted incremental hospital costs and complication probabilities were compared. Differences in surgical outcomes and costs over time were also assessed.

Results

A total of 293,967 patients were included, weighted to represent 1,408,117 patients nationwide. One fourth (26.1%; 95% CI, 25.7–26.4%) experienced ≥ 1 pre-discharge complication (range, 45.3% esophagectomy to 24.0% rectal resection). Resultant annual risk-adjusted incremental hospital costs totaled $540 million nationwide (19.5% of the overall cost of care and an average of $20,900 per patient). Costs varied substantially with both cancer/resection type and complication group, ranging from $76.7 million for colectomies with infectious complications to $0.2 million for rectal resections with urinary complications. For each resection type, infectious ($154.7 million), GI ($85.5 million), and pulmonary ($77.9 million) complications were among the most significant drivers of increased hospital cost.

Conclusions

Quantifying and comparing the impact of complications on an indication-specific level in more complex patients offers an important step toward allowing providers/payers to meaningfully prioritize the design of novel and adaptation of existing value-maximization approaches.

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Financial Disclosure

No funding specifically for this work was provided. Cheryl K Zogg, MSPH, MHS, is supported by NIH Medical Scientist Training Program Training Grant T32GM007205. She is the Primary Investigator of a grant from the Emergency Medical Foundation and American College of Emergency Physicians entitled “Understanding Emergency Medicine Providers’ Perceptions of the ACA in a Renewed Era of Healthcare Reform: National Survey and Qualitative Mixed-Methods Approach.” Adil H. Haider, MD, MPH, FACS, is the Primary Investigator of a contract (AD-1306-03980) with PCORI entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED,” a Harvard Surgery Affinity Research Collaborative (ARC) Program Grant entitled “Mitigating Disparities Through Enhancing Surgeons’ Ability To Provide Culturally Relevant Care,” and a collaborative research grant from the Henry M. Jackson Foundation for the Advancement of Military Medicine in conjunction with the Uniformed Services University of the Health Sciences entitled “The Comparative Effectiveness and Provider Induced Demand Collaboration.” Haider is also a co-founder and equity-shareholder of the company Patient Doctor Technologies, Inc., which owns and operates the website www.doctella.com.

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Authors and Affiliations

  1. Yale School of Medicine, 67 Cedar Street, Room 316 ESH, New Haven, CT, 06520, USA

    Cheryl K. Zogg, Taylor D. Ottesen, Kareem J. Kebaish & Anoop Galivanche

  2. Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Cheryl K. Zogg, Shilpa Murthy, Navin R. Changoor & Adil H. Haider

  3. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Shilpa Murthy

  4. Minnesota Gastroenterology, P.A., Saint Paul, MN, USA

    Donald L. Zogg

  5. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Timothy M. Pawlik

Authors
  1. Cheryl K. Zogg
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  2. Taylor D. Ottesen
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  3. Kareem J. Kebaish
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  4. Anoop Galivanche
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  6. Navin R. Changoor
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  7. Donald L. Zogg
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  9. Adil H. Haider
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Contributions

Zogg, Murthy, Changoor, Zogg, Pawlik, and Haider made substantial contributions to the conception or design of the work; Zogg, Ottesen, and Changoor participated in the acquisition and analysis of the data; Zogg, Ottesen, Kebaish, Galivanche, Murthy, Changoor, Zogg, Pawlik, and Haider contributed toward the interpretation of data for the work; Zogg, Ottesen, Kebaish, and Galivanche drafted the manuscript; and Murthy, Changoor, Zogg, Pawlik, and Haider critically revised the manuscript for intellectual content. All authors provided final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Cheryl K. Zogg.

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The authors declare that they have no conflict of interest.

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Zogg, C.K., Ottesen, T.D., Kebaish, K.J. et al. The Cost of Complications Following Major Resection of Malignant Neoplasia. J Gastrointest Surg 22, 1976–1986 (2018). https://doi.org/10.1007/s11605-018-3850-6

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  • DOI: https://doi.org/10.1007/s11605-018-3850-6

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