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Associations of specific postoperative complications with costs after radical cystectomy
Matthew Mossanen1,2,3, Ross E Krasnow1,2,3, Stuart R Lipsitz2
1Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Insights
Radical cystectomy (RC) complications significantly increase hospital costs, with readmissions being particularly expensive. Understanding these costs is crucial for improving patient care and resource allocation in urologic surgery.
Area of Science:
- Urology
- Health Economics
- Surgical Outcomes
Background:
- Radical cystectomy (RC) is a complex urologic procedure associated with significant morbidity.
- The financial burden of specific complications following RC is not well-characterized, hindering targeted cost-containment strategies.
Purpose of the Study:
- To quantify the financial impact of complications after radical cystectomy (RC).
- To associate specific complications with their respective 90-day costs and identify predictors of increased expenditure.
Main Methods:
- Analysis of the Premier Hospital Database including 9,137 RC patients (weighted 57,553) from 360 hospitals (2003-2013).
- Complications categorized by Agency for Healthcare Research and Quality classifications.
- Comparison of patients with and without complications using multivariable analysis.
Main Results:
- Index complications increased costs by $9,262; readmission complications increased costs by $20,697.
- Costliest index complications included venous thromboembolism (VTE) and infections; costliest readmission complications included pulmonary issues and bleeding.
- Complications increased length of stay by 4 days; 20% of patients were readmitted within 90 days.
Conclusions:
- Complications following RC substantially elevate both index and readmission costs for healthcare systems.
- Categorizing complications by cost magnitude aids in prioritizing quality improvement initiatives.
- Considering complication costs is vital for future policy and resource allocation in RC care.
Objective:
To quantify the financial impact of complications after radical cystectomy (RC) and their associations with respective 90-day costs, as RC is a morbid surgery plagued by complications and the expenditure attributed to specific complications after RC is not well characterised.
Patients And Methods:
We used the Premier Hospital Database (Premier Inc., Charlotte, NC, USA) to identify 9 137 RC patients (weighted population of 57 553) from 360 hospitals between 2003 and 2013. Complications were categorised 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% confidence interval [CI] 8 300-10 223) 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 complications, and pulmonary complications (P < 0.001, vs no complication). A complication increased length of stay by 4 days (95% CI 3.6-4.3). One in five 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, interquartile range 2-4). On multivariable analysis, more comorbidities, longer surgery (>6 h), transfusions of >3 units, and teaching hospitals were associated with higher costs (P < 0.05), whilst high-volume surgeons and shorter surgeries (<4 h) were associated with lower costs (P < 0.05).
Conclusions:
Complications after RC increase index and readmission costs for hospitals, and can be categorised based on magnitude. Future initiatives in RC may also consider costs of complications when establishing quality improvement priorities for patients, providers, or policymakers.
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