title: Postoperative Complications and Hospital Payment: Implications for Achieving Value.
abstract: BACKGROUND
  As the current healthcare structure moves toward value-based purchasing, it is helpful for stakeholders to understand costs, particularly for those associated with postoperative complications. The objectives of this study were to assess hospital reimbursements for postoperative complications and generate insight into sustainability of quality.
  
  
  METHODS
  American College of Surgeons NSQIP and Medicare claims data from 2009 to 2012 were merged for elective colectomy, total knee arthroplasty, and carotid endarterectomy. Payments associated with 7 postoperative complications across each operation were estimated from multivariable regression models. The impact on hospital marginal costs was estimated from the regression results by accounting for complication incidence rates.
  
  
  RESULTS
  Mean hospital payments per uncomplicated procedure were approximately $13,500 for colectomy (n = 19,089), $12,300 for total knee arthroplasty (n = 17,834), and $7,300 for carotid endarterectomy (n = 16,207). The payment amount per complication increased at a rate of $10,996 for colectomy, $13,732 for total knee arthroplasty, and $8,435 for carotid endarterectomy. When distinguishing between types of complications, the most expensive complication was prolonged ventilation, increasing mean payment by approximately $14,100 (colectomy) and $6,700 (carotid endarterectomy), respectively. Hospital marginal costs accounting for complication rates added additional amounts ranging from 0.82% to 9.2%.
  
  
  CONCLUSIONS
  Postoperative complications add an important marginal cost to Medicare payments, and lead to a substantial portion of payments to hospitals. Using high-quality clinical registry data to measure complication rates, we estimated the cost of complications for 3 commonly performed operations among the Medicare population. Harmonizing financial incentives for both payers and providers are needed to improve the delivery of high-quality surgical care.
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL Department of Surgery, University of Chicago Hospitals, Chicago, IL Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL Department of Surgery, Washington University in St Louis, St Louis, MO Center for Health Policy and the Olin Business School, Washington University in St Louis, St Louis, MO Saint Louis Veterans Affairs Medical Center, St Louis, MO BJC Healthcare, St Louis, MO Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Liu
authors.forename: Julia R
authors.initials: JR
authors.lastname: Berian
authors.forename: Shenglin
authors.initials: S
authors.lastname: Chen
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D003082:Colectomy / Q000191:economics; D016894:Endarterectomy, Carotid / Q000191:economics; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D011183:Postoperative Complications / Q000191:economics*; D011787:Quality of Health Care; D014481:United States; D062505:Value-Based Purchasing