Costs in Colectomy Episodes of Care: Opportunities to Prevent Emergency Operations and Decrease Costs.

Area of Science:

• Health Economics
• Surgical Outcomes
• Public Health

Background:

• Episodes of Care (EoC) payment models incentivize reduced healthcare utilization post-procedure.
• Major Bowel Episodes of Care (MB-EoC) are a key focus within general surgery.
• This study investigates the impact of emergency bowel surgery on MB-EoC costs.

Purpose of the Study:

• To determine the contribution of emergency bowel surgery to increased costs within Major Bowel Episodes of Care.
• To analyze cost drivers and patient demographics associated with MB-EoC.
• To evaluate the impact of prior screening colonoscopy on costs for eligible cancer cases.

Main Methods:

• Retrospective review of 1292 adult MB-EoC colectomy cases (July 2018-June 2021).
• Analysis of 90-day costs, patient age, insurance, diagnosis, and cost contributors.
• Examination of prior screening colonoscopy incidence in non-elective colon cancer cases (age ≥45).

Main Results:

• Emergent MB-EoC cases were 66% more costly than elective cases over 90 days.
• Non-elective cases were associated with higher rates of Medicaid/underinsurance and increased post-discharge costs.
• For colon cancer patients, emergent cases incurred 39% higher 90-day costs compared to elective cases.
• 43% of eligible emergent colon cancer cases had a prior screening colonoscopy within 10 years.

Conclusions:

• Emergency bowel surgery disproportionately drives higher 90-day healthcare utilization and costs in MB-EoC.
• Targeted increases in screening colonoscopy may significantly reduce MB-EoC expenditures.
• Understanding cost drivers is crucial for optimizing value-based care models in surgery.