Determining Hospital Cost for Postoperative Complications: A Strategy to Drive Investment into Your Colorectal Surgery Quality Improvement Program

Abstract

INTRODUCTION: Postoperative complication (POC) significantly increase healthcare cost. Identifying sources of cost variation helps implement or justify quality improvement programs. This study focuses on the incidence and POC cost after colorectal surgery (CRS). METHODS: Institutional data using the American College of Surgeons NSQIP was queried from 2013 to 2019 for patients undergoing CRS and merged with our financial database. Incidence of NSQIP-defined POC was determined in addition to index hospitalization (IHC) and 30-day post-discharge direct cost (PDCC). PDCC includes labs, imaging, clinic visits, readmission, and emergency department visits to our institution. RESULTS: A total of 2233 patients were identified, with 23.9% experiencing a POC resulting in a 1.5-4.5-fold increase in IHC and 2-15-fold increase in PDCC compared with patients who experienced no POCs. Each complication led to a significant increase in IHC/PDCC cost (p < 0.001). Most of these patients experienced one POC (N = 307, 13.7%) but the remaining experienced 2-6 POCs (N = 227, 10.1%). Anastomotic leak occurred in 5.5% (N = 123) of cases and were categorized by treatment: reoperation (N = 63), nonoperative intervention, ie percutaneous or endoscopic (N = 35), or no intervention (N = 25). All treated leaks resulted in additional significant IHC/PDCC (p <0.001). Overall rate of readmission was 10.5% and unplanned reoperation was 8.0% (Table). CONCLUSION: POC after CRS is common and adds a significant healthcare, cost both during the index hospitalization and post-discharge. This underscores the importance of and should justify investment in enhanced recovery programs, surgical site infection prevention bundles, and prehabilitation programs, which can mitigate the occurrence of many of the POCs considered. Table. - NSQIP Complication and Cost after Colorectal Surgery Characteristic N Incidence Mean index of hospitalization cost Mean 30-day post-discharge cost All Patients 2233 $27,123 ± 31,428 $3,127 ± 13,752 No Postoperative Complication 1699 76.1% $19,424 ± 12,158 $1,352 ± 5,503 Post Operative Complication(s) 534 23.9% $51,620 ± 53,621 $8,774 ± 25,563 Deep SSI 51 2.3% $49,885 ± 50,417 $21,747 ± 43,915 Organ/Space SSI 125 5.6% $54,832 ± 54,065 $13,448 ± 21,045 Sepsis 103 4.6% $40,455 ± 34,456 $7,286 ± 12,608 Respiratory Failure 184 8.2% $85,807 ± 64,197 $10,142 ± 34,231 Prolonged NPO/NGT Use aka “ileus” 494 22.1% $48,153 ± 49,561 $7,701 ± 26,274 Anastomotic Leak treated with Reoperation 63 2.8% $83,344 ± 82,075 $20,340 ± 33,018