The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients

Ann Surg. 2011 Dec;254(6):907-13. doi: 10.1097/SLA.0b013e31821d4a43.


Objective: To assess the impact of postoperative complications on full in-hospital costs per case.

Background: Rising expenses for complex medical procedures combined with constrained resources represent a major challenge. The severity of postoperative complications reflects surgical outcomes. The magnitude of the cost created by negative outcomes is unclear.

Patients and methods: Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary, high-volume center was assessed by a validated, complication score system. Full in-hospital costs were collected for each patient. Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders.

Results: This study population included 393 complex liver/bile duct surgeries, 110 major pancreas operations, 389 colon resections, and 308 Roux-en-Y gastric bypasses. The overall 30-day mortality rate was 1.8%, whereas morbidity was 53.8%. Patients with an uneventful course had mean costs per case of US$ 27,946 (SD US$ 15,106). Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 (SD US$ 151,191) for grade IV complications. This increase in costs, up to 5 times the cost of a similar operation without complications, was observed for all types of investigated procedures, although the magnitude of the increase varied, with the highest costs in patients undergoing pancreas surgery.

Conclusion: This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs. Furthermore, the study highlights a relevant savings capacity for major surgical procedures, and supports all efforts to lower negative events in the postoperative course.

Trial registration: NCT00855387.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Roux-en-Y / economics
  • Bile Duct Diseases / economics
  • Bile Duct Diseases / surgery
  • Cohort Studies
  • Colectomy / economics
  • Colonic Diseases / economics
  • Colonic Diseases / surgery
  • Costs and Cost Analysis
  • Female
  • Gastric Bypass / economics
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Liver Diseases / economics
  • Liver Diseases / surgery
  • Male
  • Middle Aged
  • Pancreatic Diseases / economics
  • Pancreatic Diseases / surgery
  • Postoperative Complications / economics*
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Quality of Health Care / economics
  • Surgical Procedures, Operative / economics*
  • Surgical Procedures, Operative / mortality
  • Survival Rate
  • Young Adult

Associated data