The financial cost of postoperative complications: a prospective cohort study with linked health systems data

Five million surgical procedures are performed annually in the UK NHS. One in five patients experience postoperative complications, causing longer admissions and additional treatments. However, the economic cost of complications is poorly understood.

This was a planned analysis of the International Surgical Outcomes Study linked to NHS England Hospital Episode Statistics data, focusing on Payment by Results (PbR), the predominant funding mechanism before COVID-19. The primary outcome was cost of postoperative complications. The secondary outcome was profit-loss, comparing PbR (income) with surgical cost accounting for complications (expenditure). We calculated expenditure of admission by multiplying length of stay by average daily ward or critical care unit costs. We defined income using the tariff linked to PbR.

We included 5167 patients undergoing surgery in the NHS in England, of whom 848 (16.4%) experienced a complication. Patients were on average 58.9 yr old, with 58.1% female and 41.9% male. Median length of stay was 7 days for patients with complications and 2 days without complications. The average cost of admission for patients with complications was £3100 (95% confidence interval [95% CI]: £2921-3279) compared with £1038 (95% CI: £1006-1070) for patients without complications. Profit-loss analysis, accounting for procedure and length of stay, showed a loss for most surgeries, regardless of complications. Average loss without complications was £930 (95% CI: £866-995) and £850 (95% CI: £629-1071) with complications.

Postoperative complications increase expenditure by ∼200%. For most procedures, expenditure exceeds income, independent of complications.