Hiraku Kumamaru1, Yoshihiro Kakeji2, Kiyohide Fushimi3, Koichi Benjamin Ishikawa4, Hiroyuki Yamamoto5, Hideki Hashimoto6, Minoru Ono7, Tadashi Iwanaka5, Shigeru Marubashi2, Mitsukazu Gotoh8, Yasuyuki Seto8, Yuko Kitagawa8, Hiroaki Miyata5. 1. Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, 7-3-1 University of Tokyo Hospital Chuoushinryoutou II, 8F, Hongo, Tokyo, 113-8655, Japan. hik205@mail.harvard.edu. 2. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 3. Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan. 4. International University of Health and Welfare, Tokyo, Japan. 5. Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, 7-3-1 University of Tokyo Hospital Chuoushinryoutou II, 8F, Hongo, Tokyo, 113-8655, Japan. 6. Department of Health and Social Behavior, The University of Tokyo School of Public Health, Tokyo, Japan. 7. Department of Cardiovascular Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. 8. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Abstract
PURPOSE: To assess the increase in hospital costs associated with postoperative complications after lower anterior resection (LAR) for rectal cancer. METHODS: The subjects of this retrospective analysis were patients who underwent elective LAR surgery between April, 2015 and March, 2017, collected from a Japanese nationwide gastroenterological surgery registry linked to hospital-based claims data. We evaluated total and category-specific hospitalization costs based on the level of postoperative complications categorized using the Clavien-Dindo (CD) classification. We assessed the relative increase in hospital costs, adjusting for preoperative factors and hospital case volume. RESULTS: We identified 15,187 patients (mean age 66.8) treated at 884 hospitals. Overall, 71.8% had no recorded complications, whereas 7.6%, 10.8%, 9.0%, 0.6%, and 0.2% had postoperative complications of CD grades I-V, respectively. The median (25th-75th percentiles) hospital costs were $17.3 K (16.1-19.3) for the no-complications group, and $19.1 K (17.3-22.2), $21.0 K (18.5-25.0), $27.4 K (22.4-33.9), $41.8 K (291-618), and $22.7 K (183-421) for the CD grades I-V complication groups, respectively. The multivariable model identified that complications of CD grades I-V were associated with 11%, 21%, 61%, 142%, and 70% increases in in-hospital costs compared with no complications. CONCLUSIONS: Postoperative complications and their severity are strongly associated with increased hospital costs and health-care resource utilization. Implementing strategies to prevent postoperative complications will improve patients' clinical outcomes and reduce hospital care costs substantially.
PURPOSE: To assess the increase in hospital costs associated with postoperative complications after lower anterior resection (LAR) for rectal cancer. METHODS: The subjects of this retrospective analysis were patients who underwent elective LAR surgery between April, 2015 and March, 2017, collected from a Japanese nationwide gastroenterological surgery registry linked to hospital-based claims data. We evaluated total and category-specific hospitalization costs based on the level of postoperative complications categorized using the Clavien-Dindo (CD) classification. We assessed the relative increase in hospital costs, adjusting for preoperative factors and hospital case volume. RESULTS: We identified 15,187 patients (mean age 66.8) treated at 884 hospitals. Overall, 71.8% had no recorded complications, whereas 7.6%, 10.8%, 9.0%, 0.6%, and 0.2% had postoperative complications of CD grades I-V, respectively. The median (25th-75th percentiles) hospital costs were $17.3 K (16.1-19.3) for the no-complications group, and $19.1 K (17.3-22.2), $21.0 K (18.5-25.0), $27.4 K (22.4-33.9), $41.8 K (291-618), and $22.7 K (183-421) for the CD grades I-V complication groups, respectively. The multivariable model identified that complications of CD grades I-V were associated with 11%, 21%, 61%, 142%, and 70% increases in in-hospital costs compared with no complications. CONCLUSIONS: Postoperative complications and their severity are strongly associated with increased hospital costs and health-care resource utilization. Implementing strategies to prevent postoperative complications will improve patients' clinical outcomes and reduce hospital care costs substantially.
Authors: Takayuki Anazawa; Jennifer L Paruch; Hiroaki Miyata; Mitsukazu Gotoh; Clifford Y Ko; Mark E Cohen; Norimichi Hirahara; Lynn Zhou; Hiroyuki Konno; Go Wakabayashi; Kenichi Sugihara; Masaki Mori Journal: Medicine (Baltimore) Date: 2015-12 Impact factor: 1.817