title: Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals.
abstract: BACKGROUND
  Healthcare providers worldwide are struggling with rising costs while hospitals budgets are under stress. Colorectal cancer surgery is commonly performed, however it is associated with a disproportionate share of adverse events in general surgery. Since adverse events are associated with extra hospital costs it seems important to explicitly discuss the costs of complications and the risk factors for high-costs after colorectal surgery.
  
  
  METHODS
  Retrospective analysis of clinical and financial outcomes after colorectal cancer surgery in 29 Dutch hospitals (6768 patients). Detailed clinical data was derived from the 2011-2012 population-based Dutch Surgical Colorectal Audit database. Costs were measured uniform in all participating hospitals and based on Time-Driven Activity-Based Costing.
  
  
  RESULTS
  Of total hospital costs in this study, 31% was spent on complications and the top 5% most expensive patients were accountable for 23% of hospitals budgets. Minor and severe complications were respectively associated with a 26% and 196% increase in costs as compared to patients without complications. Independent from other risk factors, ASA IV, double tumor, ASA III, short course preoperative radiotherapy and TNM-4 stadium disease were the top-5 attributors to high costs.
  
  
  CONCLUSIONS
  This article shows that complications after colorectal cancer surgery are associated with a substantial increase in costs. Although not all surgical complications can be prevented, reducing complications will result in considerable cost savings. By providing a business case we show that investments made to develop targeted quality improvement programs will pay off eventually. Results based on this study should encourage healthcare providers to endorse quality improvement efforts.
authors.affiliation: Leiden University Medical Center, Department of Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Groene Hart Ziekenhuis, Department of Surgery, Bleulandweg 10, 2803 HH Gouda, The Netherlands. Electronic address: J.A.Govaert@lumc.nl.
authors.forename: J A
authors.initials: JA
authors.lastname: Govaert
authors.affiliation: Leiden University Medical Center, Department of Medical Statistics and Bioinformatics, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Leiden University Mathematical Institute, Niels Bohrweg 1, 233 CA Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: Performation, Sweelincklaan 1, 3723 JA Bilthoven, The Netherlands; X-is, Vrouwjuttenland 13, 2611 LB Delft, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: van Dijk
authors.affiliation: Performation, Sweelincklaan 1, 3723 JA Bilthoven, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Scheffer
authors.affiliation: IJsselland Hospital, Capelle aan den IJssel, Department of Surgery, Prins Constantijnweg 2, 2906 ZC Capelle aan den IJssel, The Netherlands.
authors.forename: E J R
authors.initials: EJ
authors.lastname: de Graaf
authors.affiliation: Leiden University Medical Center, Department of Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.affiliation: Leiden University Medical Center, Department of Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Department of Surgical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000191:economics* / Q000601:surgery*; D003107:Colorectal Surgery / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D009426:Netherlands; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Colorectal surgery; Complications; Costs; Dutch Surgical Colorectal Audit