Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct 7:3:7.
doi: 10.1186/2047-0525-3-7. eCollection 2014.

Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures

Lee A Fleisher  1 , Walter T Linde-Zwirble  2
Affiliations

Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures

Lee A Fleisher et al. Perioper Med (Lond). .

Abstract

Background: Complications increase the costs of care of surgical patients. We studied the Premier database to determine the incidence and direct medical costs related to pulmonary complications and compared it to cardiac complications in the same cohort.

Methods: We identified 45,969 discharges in patients undergoing major bowel procedures. Postoperative pulmonary and cardiac complications were identified through the use of International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes and through the use of daily resource use data. Pulmonary complications included pneumonia, tracheobronchitis, pleural effusion, pulmonary failure, and mechanical ventilation more than 48 h after surgery. Cardiac complications included ventricular fibrillation, acute myocardial infarction, cardiogenic shock, cardiopulmonary arrest, transient ischemia, premature ventricular contraction, and acute congestive heart failure.

Results: Postoperative pulmonary complications (PPC) or postoperative cardiac complications (PCC) were present in 22% of cases; PPC alone was most common (19.0%), followed by PPC and PCC (1.8%) and PCC alone (1.2%). The incremental cost of PPC is large ($25,498). In comparison, PCC alone only added $7,307 to the total cost.

Conclusions: The current study demonstrates that postoperative pulmonary complications represent a significant source of morbidity and incremental cost after major small intestinal and colon surgery and have greater incidence and costs than cardiac complications alone. Therefore, strategies to reduce the incidence of these complications should be targeted as means of improving health and bending the cost curve in health care.

Keywords: Cardiac arrest; Colectomy; Cost; Myocardial infarction; Pneumonia; Postoperative; Pulmonary complications; Surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Incidence, case distribution, and mortality for postoperative complication groups.
Figure 2
Figure 2
Base and incremental mortalities for postoperative complication groups by preoperative severity groups.
Figure 3
Figure 3
Base and incremental costs for postoperative complication groups by preoperative severity groups.
See this image and copyright information in PMC

References

    1. Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–2137. doi: 10.1056/NEJMsa1010705. - DOI - PMC - PubMed
    1. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361:1368–1375. doi: 10.1056/NEJMsa0903048. - DOI - PubMed
    1. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson TM, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014. - PubMed
    1. Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med. 2011;39:2163–2172. doi: 10.1097/CCM.0b013e31821f0522. - DOI - PubMed
    1. Gupta H, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, Morrow LE. Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 2011;140:1207–1215. doi: 10.1378/chest.11-0466. - DOI - PubMed

LinkOut - more resources