title: What is the inpatient cost of hospital complications or death after lobectomy or pneumonectomy?
abstract: BACKGROUND
  No information exists evaluating the costs of complications or death after lobectomy or pneumonectomy.
  
  
  METHODS
  We analyzed hospital costs for 294 patients who underwent lobectomy (n=268) or pneumonectomy (n=26) from January 2005 through September 2007. The patients were categorized into two groups on the basis of clinical outcomes: uncomplicated versus complications or death. A cost prediction model was constructed with linear regression using uncomplicated patients only. The model was applied to the complications or death group to predict the expected cost as if they had no complication. The risk-adjusted cost of complications or death was quantified by the difference between the observed cost and the expected cost.
  
  
  RESULTS
  There were 241 patients in the uncomplicated group (19 pneumonectomy), and 53 patients had complications or death (7 pneumonectomy). Length of stay was shorter for uncomplicated versus complications or death for both lobectomy and pneumonectomy. Pneumonectomy was costlier than lobectomy. Experiencing complications or death was costlier than costs associated with uncomplicated cases. The actual cost for uncomplicated cases was $18,380. The expected cost for complications or death was similar to that for uncomplicated cases regardless of the number of complications or death. The mean risk-adjusted cost of complications (95% confidence interval) increased by the number of complications: $11,693 ($4,430 to $18,957), $26,673 ($12,320 to $41,025) and $128,450 ($93,971 to $162,930) for 1, 2, and 3 complications, respectively. It was $49,823 ($23,187 to $76,459) for death.
  
  
  CONCLUSIONS
  Patients experiencing complications or death have a similar perioperative risk profile as patients without complications. Hospital death or postoperative complications after lobectomy or pneumonectomy are economically costly. Decreasing inpatient death or complications would result in substantial cost-of-care savings.
authors.affiliation: Providence Cancer Center, Providence Health & Services, Portland, Oregon; Oregon Thoracic & Cardiovascular Surgery, The Oregon Clinic, Portland, Oregon 97213, USA. jhandy@orclinic.com
authors.forename: John R
authors.initials: JR
authors.lastname: Handy
authors.forename: Kelly
authors.initials: K
authors.lastname: Denniston
authors.forename: Gary L
authors.initials: GL
authors.lastname: Grunkemeier
authors.forename: Ying Xing
authors.initials: YX
authors.lastname: Wu
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008171:Lung Diseases / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome