The Costs of Postoperative Complications After Major Abdominal Surgery: Opportunities and Challenges

Key Points

• Major abdominal surgery is associated with a high prevalence of complications.

• Postoperative complications are associated with increased hospital costs.

• Postoperative complications are associated with increased hospital length of stay.

• Minor complications (Clavien-Dindo grade I and II) are common and associated with a significant increase in costs.

• Preventing complications is a key target for cost containment.

Introduction

Cost-effective health care in the hospital setting is crucial for the sustainability of our health care system. With the rising costs of providing health care, governments and health care institutions need to consider the composition of cost expenditure. Internationally, health care expenditure has increased at a faster annual rate than economy growth, and now represents approximately 10% of global gross domestic product (GDP). On a global perspective, $7.2 trillion is estimated to be spent on health care annually, with 35%–40% of these costs attributed directly towards hospital costs. In some countries, hospital expenditure has been reported to represent more than 38% of total health care expenditure. Logically, hospital costs represent the single greatest economic target for reducing health care expenditure. Postoperative complications have been reported as being the strongest indicators of in-hospital costs. ^, While numerous mitigation strategies have aimed at reducing their occurrence, postoperative surgical complications remain common and are associated with both poorer health and cost outcomes.

In order to better understand opportunities for cost containment to reduce improvident spending, it is imperative to appreciate the hospital costs of complications following surgery. Given that major abdominal surgery is a commonly performed complex intervention of high acuity, with known risks of complications causing morbidity and mortality, we provide a contemporary overview of the drivers for hospital costs associated with major surgical procedures. Relevant to colonic, rectal, liver resection and pancreatic surgery, this chapter reviews (i) the costs of individual complications after surgery, (ii) the association of severity of complications and hospital costs, (iii) the costs associated with postoperative complications by surgical technique, (iv) the costs associated with postoperative complications by surgical urgency (emergency or elective), and (iv) the impact of complications on length of hospital stay and 30-day readmission rates.

A detailed search strategy was constructed based on the topic title and applied to EconLit MEDLINE, EMBASE, and The Cochrane Library. MeSH terms and free-text terms on costs, health economics, colonic, rectal, pancreatic and liver resections, and complications were used. Eligible studies had their data extracted into predetermined categories, which included study characteristics, procedure and surgical technique used, incidence of complications, their severity and mortality, length of stay, and 30-day readmission rates. All currencies were converted to a standardized form of $USD, taking into account inflation for the respective currency using a validated online application.