title: Resource utilization in esophagectomy: When higher costs are associated with worse outcomes.
abstract: BACKGROUND
  Care of the esophagectomy patient requires significant resources. We sought to determine which patient and provider variables contribute to resource utilization and their association with clinical outcomes.
  
  
  METHODS
  6,737 patients undergoing esophagectomy were identified from the University Healthsystem Consortium (UHC). Linear and logistic regression models were used to determine whether characteristics, including age, severity of illness (SOI) and procedural volume were associated with mortality, length of stay (LOS), discharge disposition, readmission rates, and cost.
  
  
  RESULTS
  Older patients were twice as likely to suffer post-operative death (OR 2.12; 95%CI 1.7-2.7), three times more likely to be discharged to extended care facilities (31.9% vs. 10.6%, P < 0.001), and cost 8.4% more ($27,628 vs. $25,481, P < 0.001). Similarly, patients with higher SOI were more likely to suffer post- operative death (OR 14.6; 4.7-45.9), be readmitted (OR 1.3; 1.1-1.6), and have longer hospital stays (RR 1.3; 1.8-2.1). Patients with the highest index hospital costs were five times more likely to be discharged to an extended care facility (P < 0.001).
  
  
  CONCLUSIONS
  Older patients and those with a higher SOI have higher perioperative mortality, readmission rates, hospital costs, and require more post- operative care. With increasingly scrutinized health care costs, these data provide guidance for more careful patient selection.
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Shrawan G
authors.initials: SG
authors.lastname: Gaitonde
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Cincinnati Research on Outcomes and Safety in Surgery (CROSS), University of Cincinnati, Cincinnati, Ohio.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000191:economics* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D009367:Neoplasm Staging; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
keywords: cost efficiency; esophagectomy; resource utilization