3 years ago

Associations of Specific Postoperative Complications with Costs after Radical Cystectomy

Jeffrey J. Leow, Angela B. Smith, Albert Ha, Quoc D. Trinh, Adam S. Kibel, Stuart R Lipsitz, Ross E. Krasnow, Steven L. Chang, Mark A. Preston, Matthew Mossanen, John L. Gore
Background Radical cystectomy (RC) is a morbid surgery plagued by complications. Expenditures attributed to specific complications after RC is not well characterized. We sought to quantify the financial impact of complications after RC and their associations with respective 90-day costs. Methods We used the Premier Hospital Database to identify 9,137 RC patients (weighted population of 57,553) from 360 hospitals between 2003-2013. Complications were categorized according to Agency for Healthcare Research and Quality Clinical Classifications. Patients with and without complications were compared and multivariable analysis was performed. Results An index complication increased costs by $9,262 [95% CI 8300-10,223] and a readmission complication increased costs by $20,697 [95%CI 18,735-22,660]. The four most costly index complications (descending order) were venous thromboembolism (VTE), infection, wound and soft tissue event, and pulmonary (p<0.001, vs. no complication). A complication increased length of stay by 4 days [95%CI 3.6-4.3]. One in 5 patients were readmitted in 90 days and the four costliest readmission complications (descending order) were pulmonary, bleeding, VTE, and gastrointestinal complications (p<0.001, vs. no complication). Readmitted patients had multiple complications upon readmission (median of 3, IQR 2-4). On multivariable analysis, more comorbidities, longer surgery (>6 hours), transfusions > 3 units, and teaching hospitals were associated with higher costs (p<0.05) while high volume surgeons and shorter surgeries (<4 hours) were associated lower costs (p<0.05). Conclusions Complications after RC increase index and readmission costs for hospitals, and can be categorized based on magnitude. Future initiatives in RC may also consider costs of complications when establishing quality improvement priorities for patients, providers, or policymakers. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/bju.14064

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