title: Hospital costs associated with smoking in veterans undergoing general surgery.
abstract: BACKGROUND
  Approximately 30% of patients undergoing elective general surgery smoke cigarettes. The association between smoking status and hospital costs in general surgery patients is unknown. The objectives of this study were to compare total inpatient costs in current smokers, former smokers, and never smokers undergoing general surgical procedures in Veterans Affairs (VA) hospitals; and to determine whether the relationship between smoking and cost is mediated by postoperative complications.
  
  
  METHODS
  Patients undergoing general surgery during the period of October 1, 2005 to September 30, 2006 were identified in the VA Surgical Quality Improvement Program (VASQIP) data set. Inpatient costs were extracted from the VA Decision Support System (DSS). Relative surgical costs (incurred during index hospitalization and within 30 days of operation) for current and former smokers relative to never smokers, and possible mediators of the association between smoking status and cost were estimated using generalized linear regression models. Models were adjusted for preoperative and operative variables, accounting for clustering of costs at the hospital level.
  
  
  RESULTS
  Of the 14,853 general surgical patients, 34% were current smokers, 39% were former smokers, and 27% were never smokers. After controlling for patient covariates, current smokers had significantly higher costs compared with never smokers: relative cost was 1.04 (95% Cl 1.00 to 1.07; p = 0.04); relative costs for former smokers did not differ significantly from those of never smokers: 1.02 (95% Cl 0.99 to 1.06; p = 0.14). The relationship between smoking and hospital costs for current smokers was partially mediated by postoperative respiratory complications.
  
  
  CONCLUSIONS
  These findings complement emerging evidence recommending effective smoking cessation programs in general surgical patients and provide an estimate of the potential savings that could be accrued during the preoperative period.
authors.affiliation: The Center for Comprehensive Access & Delivery Research and Evaluation at the Iowa City VA Healthcare System, Iowa City, IA, USA. aparna-kamath@uiowa.edu
authors.forename: Aparna S
authors.initials: AS
authors.lastname: Kamath
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan Sarrazin
authors.forename: Mark W
authors.initials: MW
authors.lastname: Vander Weg
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.forename: Joseph
authors.initials: J
authors.lastname: Cullen
authors.forename: David A
authors.initials: DA
authors.lastname: Katz
mesh_terms: D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006787:Hospitals, Veterans / Q000191:economics*; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000191:economics* / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000191:economics*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D014728:Veterans