title: Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy.
abstract: OBJECTIVE
  Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions.
  
  
  METHODS
  The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests.
  
  
  RESULTS
  Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P<0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P<0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation.
  
  
  CONCLUSIONS
  Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures.
authors.affiliation: Centre hospitalier d'Argenteuil, 95107 Argenteuil, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Landais
authors.affiliation: Centre hospitalier et universitaire de Rennes, 35033 Rennes, France.
authors.forename: Morgane
authors.initials: M
authors.lastname: Morel
authors.affiliation: Edwards Lifesciences, 1050 Bruxelles, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Goldstein
authors.affiliation: Groupe hospitalier Paris St.-Joseph, 75014 Paris, France.
authors.forename: Jerôme
authors.initials: J
authors.lastname: Loriau
authors.affiliation: Centre hospitalier et universitaire de Rennes, 35033 Rennes, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Fresnel
authors.affiliation: Centre hospitalier d'Argenteuil, 95107 Argenteuil, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Chevalier
authors.affiliation: Groupe hospitalier Paris St.-Joseph, 75014 Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rejasse
authors.affiliation: Groupe hospitalier Paris St.-Joseph, 75014 Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Alfonsi
authors.affiliation: Centre hospitalier et universitaire de Rennes, 35033 Rennes, France. Electronic address: claude.ecoffey@chu-rennes.fr.
authors.forename: Claude
authors.initials: C
authors.lastname: Ecoffey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France; D006040:Goals; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics*
keywords: Cost savings; Diagnosis related groups and severity scores; High-risk surgery; Length of hospital stay; Perioperative goal-directed therapy; Postoperative complication