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. 2023 Feb 24;18(2):e0282324.
doi: 10.1371/journal.pone.0282324. eCollection 2023.

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study

Laurence Weinberg  1   2   3 , Sarah Aishah Azlina Aitken  1 , Peter Kaldas  2 , Luke Fletcher  2   4 , Patryck Lloyd-Donald  1 , Peter Le  1 , Daniel Do  1 , Carla Borg Caruana  1 , Dominic Walpole  1 , Joseph Ischia  2 , Ronald Ma  5 , Chong Oon Tan  1 , Dong-Kyu Lee  6
Affiliations

Postoperative complications and hospital costs following open radical cystectomy: A retrospective study

Laurence Weinberg et al. PLoS One. .

Abstract

Objectives: To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy.

Methods: Postoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien-Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model.

Results: 135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9-53,532.5) and $81,050.1 (49,614.8-122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%-76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%-181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08-1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23-5.07) respectively.

Conclusions: These findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies.

Trial registration: Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN:12622000057785.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Consort diagram.
Fig 2
Fig 2
Unadjusted hospital costs categorised by the severity of complications (A) and the number of complications (B). Severity of complications graded by the Clavien–Dindo (CVD) surgical complication classification grades (* vs no complication; † vs CVD Grade I; ‡ vs CVD Grade II). Numbers of complications per patient classified as 0, 1–5 or ≥ 6 complications (* vs no complication; † vs 1–5 complications). Post-hoc Dunn’s test applied after the Kruskal–Wallis one-way analysis of variance on ranks.
Fig 3
Fig 3. Overall Kaplan-Meier survival curve of cystectomy patients.
Any cross marks the censored data at that time point. Shaded areas indicate 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33. doi: 10.3322/caac.21654 - DOI - PubMed
    1. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al.. Cancer statistics for the year 2020: an overview. Int J Cancer. 2021;149(4):778–89. doi: 10.1002/ijc.33588 - DOI - PubMed
    1. Teoh JY-C, Huang J, Ko WY-K, Lok V, Choi P, Ng C-F, et al.. Global trends of bladder cancer incidence and mortality, and their associations with tobacco use and gross domestic product per capita. Eur Urol. 2020;78(6):893–906. doi: 10.1016/j.eururo.2020.09.006 - DOI - PubMed
    1. Abdollah F, Gandaglia G, Thuret R, Schmitges J, Tian Z, Jeldres C, et al.. Incidence, survival and mortality rates of stage-specific bladder cancer in United States: a trend analysis. Cancer Epidemiol. 2013;37(3):219–25. doi: 10.1016/j.canep.2013.02.002 - DOI - PubMed
    1. Flaig TW, Spiess PE, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, et al.. Bladder cancer, version 3.2020, NCCN clinical practice guidelines in Oncology. J Natl Compr Canc Netw. 2020;18(3):329–54. doi: 10.6004/jnccn.2020.0011 - DOI - PubMed