title: Hospital costs of complications after esophagectomy for cancer.
abstract: OBJECTIVE
  The purpose of this study was to estimate the economic burden of postoperative complications after esophagectomy for cancer, in order to optimally allocate resources for quality improvement initiatives in the future.
  
  
  METHODS
  A retrospective analysis of prospectively collected clinical and financial outcomes after esophageal cancer surgery in a tertiary referral center in the Netherlands was performed. Data was extracted from consecutive patients registered in the Dutch Upper GI Cancer Audit between 2011 and 2014 (n = 201). Costs were measured up to 90-days after hospital discharge and based on Time-Driven Activity-Based Costing. The additional costs were estimated using multiple linear regression models.
  
  
  RESULTS
  The average total cost for one patient after esophagectomy was €37,581 (±31,372). The estimated costs of an esophagectomy without complications were €23,476 (±6496). Mean costs after minor (47%) and severe complications (29%) were €31,529 (±23,359) and €59,167 (±42,615) (p < 0.001), respectively. The 5% most expensive patients were responsible for 20.3% of the total hospital costs assessed in this study. Patient characteristics associated with additional costs in multivariable analysis included, age >70 (+€2,922, p = 0.036), female gender (+€4,357, p = 0.005), COPD (+€5,415, p = 0.002), and a history of thromboembolic events (+€6,213, p = 0.028). Complications associated with a significant increase in costs in multivariable analysis included anastomotic leakage (+€4,123, p = 0.008), cardiac complications (+€5,711, p = 0.003), chyle leakage (+€6,188, p < 0.001) and postoperative bleeding (+€31,567, p < 0.001).
  
  
  CONCLUSIONS
  Complications and severity of complications after esophageal surgery are associated with a substantial increase in costs. Although not all postoperative complications can be prevented, implementation of preventive measures to reduce complications could result in a considerable cost reduction and quality improvement.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands. Electronic address: L.Goense-2@umcutrecht.nl.
authors.forename: L
authors.initials: L
authors.lastname: Goense
authors.affiliation: X-IS, Delft, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: van Dijk
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Govaert
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
authors.forename: P S N
authors.initials: PS
authors.lastname: van Rossum
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Ruurda
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: R.vanHillegersberg@umcutrecht.nl.
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000367:Age Factors; D000368:Aged; D057868:Anastomotic Leak / Q000191:economics; D015897:Comorbidity; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006331:Heart Diseases / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000191:economics*; D019106:Postoperative Hemorrhage / Q000191:economics; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D058996:Quality Improvement; D012189:Retrospective Studies; D012737:Sex Factors; D013923:Thromboembolism / Q000453:epidemiology
keywords: Complications; Dutch upper GI cancer audit; Esophageal cancer; Esophagectomy; Health care costs