Rethinking Priorities: Cost of Complications After Elective Colectomy

Ann Surg. 2016 Aug;264(2):312-22. doi: 10.1097/SLA.0000000000001511.


Objective: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses.

Summary background data: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking.

Methods: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared.

Results: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3% was due to complications [1.9% due to current Centers for Medicare and Medicaid Services (CMS) complications].

Conclusions: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Colectomy / adverse effects*
  • Colectomy / economics
  • Colonic Diseases / surgery*
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / economics
  • Female
  • Health Care Costs*
  • Health Priorities
  • Hospitalization
  • Humans
  • Laparoscopy / adverse effects*
  • Laparoscopy / economics
  • Male
  • Middle Aged
  • Postoperative Complications / economics*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • United States
  • Young Adult