title: Hospital costs of colorectal cancer surgery for the oldest old: A Dutch population-based study.
abstract: Background Due to increasing healthcare costs, discussions regarding increased hospital costs when operating on high-risk patients is rising. Therefore, the aim of this study was to analyze if oldest-old colorectal cancer patients have a greater impact on hospital costs than their younger counterparts.
  
  
  METHODS
  All colorectal cancer procedures performed in 29 Dutch hospitals between 2010 and 2012 and listed in the Dutch Surgical Colorectal Audit were analyzed. Oldest-old patients (≥85 years) were compared to patients <85 years. Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costs.
  
  
  RESULTS
  Compared to <85-year-old patients (n = 9130), the oldest old (n = 783) had longer hospital stays (LOS) (11.3 vs. 13.2, P < 0.001), more severe complications (21.8% vs. 29.0%, P < 0.001), more failure to rescue (13.9% vs. 37.0%, P < 0.001) and higher mortality (3.0% vs. 10.7%, P < 0.001). Deceased oldest-old patients had significantly less LOS and less LOS ICU. Total hospital costs were 3% lower for oldest-old patients (€13,168) than for <85-year-old patients (€13,644, P < 0.001). In cases of severe complications or death, hospital costs for the oldest old were 25% and 31% lower than those of <85-year-old patients (both P < 0.001).
  
  
  CONCLUSIONS
  Although frequently assumed to be more expensive, operating on oldest-old patients with colorectal cancer does not increase hospital costs compared to younger patients. This was most likely due to faster deterioration or less aggressive treatment of oldest-old patients when (severe) complications occurred. J. Surg. Oncol. 2016;114:1009-1015. © 2016 Wiley Periodicals, Inc.
authors: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.|Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands.
authors: Johannes A
authors: JA
authors: Govaert
authors: Westfriesgasthuis, Hoorn, The Netherlands.
authors: Marc J P M
authors: MJ
authors: Govaert
authors: Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.|Leiden University Mathematical Institute, Leiden, The Netherlands.
authors: Marta
authors: M
authors: Fiocco
authors: Performation, Bilthoven, The Netherlands.|XIS, Delft, The Netherlands.
authors: Wouter A
authors: WA
authors: van Dijk
authors: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.|Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
authors: Rob A E M
authors: RA
authors: Tollenaar
authors: Dutch Institute for Clinical Auditing, Leiden, The Netherlands.|Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Michel W J M
authors: MW
authors: Wouters
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000191:economics; D003082:Colectomy / Q000191:economics* / Q000379:methods; D015179:Colorectal Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome
keywords: Dutch Surgical Colorectal Audit; colon cancer; elderly; frail patients; rectum cancer