title: The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Vonlanthen
authors.forename: Ksenija
authors.initials: K
authors.lastname: Slankamenac
authors.forename: Stefan
authors.initials: S
authors.lastname: Breitenstein
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
authors.forename: Markus K
authors.initials: MK
authors.lastname: Muller
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.forename: Dimitri
authors.initials: D
authors.lastname: Hauri
authors.forename: Rolf
authors.initials: R
authors.lastname: Graf
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000191:economics; D001649:Bile Duct Diseases / Q000191:economics / Q000601:surgery; D015331:Cohort Studies; D003082:Colectomy / Q000191:economics; D003108:Colonic Diseases / Q000191:economics / Q000601:surgery; D003365:Costs and Cost Analysis; D005260:Female; D015390:Gastric Bypass / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008107:Liver Diseases / Q000191:economics / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000191:economics / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D011787:Quality of Health Care / Q000191:economics; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000401:mortality; D015996:Survival Rate; D055815:Young Adult