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
Comparative Study
. 2018 Nov;22(11):1976-1986.
doi: 10.1007/s11605-018-3850-6. Epub 2018 Jun 26.

The Cost of Complications Following Major Resection of Malignant Neoplasia

Cheryl K Zogg  1   2 , Taylor D Ottesen  3 , Kareem J Kebaish  3 , Anoop Galivanche  3 , Shilpa Murthy  4   5 , Navin R Changoor  4 , Donald L Zogg  6 , Timothy M Pawlik  7 , Adil H Haider  4
Affiliations
Comparative Study

The Cost of Complications Following Major Resection of Malignant Neoplasia

Cheryl K Zogg et al. J Gastrointest Surg. 2018 Nov.

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.

Keywords: Cancer; Complication; Cost; Infection; Oncology; Quality; Value.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None

Figures

Figure 1.
Figure 1.
Schematic of inclusion and exclusion criteria
Figure 2.
Figure 2.
A. Total annual index hospital cost for major oncologic malignant resections in the United States, 2001–2014. B. Breakdown of annual incremental costs by system-based complication group. C. Changes in annual incremental costs overall and for colonic resection, 2001-2014
Figure 2.
Figure 2.
A. Total annual index hospital cost for major oncologic malignant resections in the United States, 2001–2014. B. Breakdown of annual incremental costs by system-based complication group. C. Changes in annual incremental costs overall and for colonic resection, 2001-2014
Figure 2.
Figure 2.
A. Total annual index hospital cost for major oncologic malignant resections in the United States, 2001–2014. B. Breakdown of annual incremental costs by system-based complication group. C. Changes in annual incremental costs overall and for colonic resection, 2001-2014
See this image and copyright information in PMC

References

    1. Health Expenditures Data for the U.S. May 2017, Centers for Disease Control and Prevention, National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/fastats/health-expenditures.htm. Accessed January 1, 2018.
    1. National Health Expenditure Projections 2015-2025 Centers for Medicare and Medicaid Services (CMS). Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren.... Accessed January 1, 2018.
    1. GDP per capita growth (annual %): United States 2017, The World Bank Group. Available at: http://data.worldbank.org/indicator/NY.GDP.PCAP.KD.ZG?locations=US. Accessed January 1, 2018.
    1. Porter ME. What is value in health care? N Engl J Med 2010; 363(26):2477–81. - PubMed
    1. Birkmeyer JD, Gust C, Baser O, et al. Medicare payments for common inpatient procedures: implications for episode-based payment bundling. Health Serv Res 2010; 45(6 Pt 1):1783–95. - PMC - PubMed

Publication types

MeSH terms