title: Impact of processes of care aimed at complication reduction on the cost of complex cancer surgery.
abstract: OBJECTIVE
  Health care providers add multiple processes to the care of complex cancer patients, believing they prevent and/or ameliorate complications. However, the relationship between these processes, complication remediation, and expenditures is unknown.
  
  
  METHODS
  Data for patients with cancer diagnoses undergoing colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection were obtained from hospital and inpatient physician Medicare claims for the years 2005-2009. Risk-adjusted regression analyses measured the association between hospitalization costs and processes presumed to prevent and/or remedy complications common to high-risk procedures.
  
  
  RESULTS
  After controlling for comorbidities, analysis identified associations between increased costs and use of multiple processes, including arterial lines (4-12% higher; P < 0.001) and pulmonary artery catheters (23-33% higher; P < 0.001). Epidural analgesia was not associated with higher costs. Consultations were associated with 24-44% (P < 0.001) higher costs, and total parenteral nutrition was associated with 13-31% higher costs (P < 0.001).
  
  
  CONCLUSIONS
  Many frequently utilized processes and services presumed to avoid and/or ameliorate complications are associated with increased surgical oncology costs. This suggests that the patient-centered value of each process should be measured on a procedure-specific basis. Likewise, further attention should be focused on defining the efficacy of each of these costly, but frequently unproven, additions to perioperative care.
authors.affiliation: Baker Institute for Public Policy at Rice University, Houston, Texas.
authors.forename: Marah N
authors.initials: MN
authors.lastname: Short
authors.affiliation: Baker Institute for Public Policy and Department of Economics, Rice University, Houston, Texas.|Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Vivian
authors.initials: V
authors.lastname: Ho
authors.affiliation: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000191:economics; D016629:Esophagectomy / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare; D009369:Neoplasms / Q000191:economics* / Q000601:surgery*; D010180:Pancreatectomy / Q000191:economics; D011013:Pneumonectomy / Q000191:economics; D011183:Postoperative Complications / Q000191:economics*; D013514:Surgical Procedures, Operative / Q000191:economics*; D014481:United States
keywords: cancer; cost analysis; process of care; surgery