title: Estimating the Annual Incremental Cost of Several Complications Following Pulmonary Lobectomy.
abstract: Determine the incremental increase in cost as well as length of hospital stay associated with several major complications following pulmonary lobectomy using a large national dataset. A retrospective cohort analysis of the 2012 National Inpatient Sample, Healthcare Cost and Utilization Project database was performed. Demographic and clinical data on patients ≥18 years having undergone an open or VATS lobectomy were included in the analysis. The median increase in cost and length of stay associated with relevant major complications were determined using a multivariable quantile regression model. Nearly one-quarter (24.9%) of hospitalizations for pulmonary lobectomy resulted in at least one complication such as air leak and acute respiratory failure, among others. The most costly complication was empyema with fistula, which was associated with a median net increase in hospital cost of $21,427 and an increased length of hospital stay of 11.6 days. Overall, however, acute respiratory failure accounted for the largest increase in aggregate national costs-$13.4 million. The most common complication was postoperative air leak, which was associated with a median net increase in cost and length of hospitalization of $3219 and 1.9 days, respectively. In aggregate, these complications accounted for nearly $40 million of annual health care expenditures. Complications following pulmonary lobectomy significantly increase in the cost and length of hospitalization. This data has the potential to help identify future areas of improvement, especially in today's era of shifting reimbursement policies aimed at cutting costs and improving health care quality.
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Oliver K
authors.initials: OK
authors.lastname: Jawitz
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina; Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina; Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.affiliation: Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Zuoheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, North Carolina; Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: anthony.kim@yale.edu.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D018803:Models, Economic; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Complications; Cost; Lobectomy; Open; Thoracoscopy; VATS