title: The Severity of Complications Is Associated With Postoperative Costs After Lung Resection.
abstract: BACKGROUND
  The objective of this study was to verify the association between the thoracic mortality and morbidity (TMM) classification system and hospital costs after lung resection.
  
  
  METHODS
  Consecutive patients (n = 503) submitted to anatomic lung resections were analyzed (April 1, 2014, to March 31, 2016). TMM system was used to grade the severity of complications. Postoperative costs were retrieved from the financial department using an electronic patient-level information system.
  
  
  RESULTS
  Two hundred seventy-two patients (54%) did not experience any complication. The distribution of postoperative complications in the remaining patients according to the TMM classification system was as follows: 57 (25%) grade I, 108 (47%) grade II, 29 (12%) grade III, 17 (7%) grade IV, and 20 (9%) grade V. The average postoperative cost of the uncomplicated patients was $3,560 (95% confidence interval [CI]: $3,440 to $3,680). The average postoperative costs of the patients with complications increased along with the grade of the TMM system; it was $4,548 (95% CI: $4,134 to $4,962) for grade I, $4,909 (95% CI: $4,537 to $5,281) for grade II, $6,392 (95% CI: $5,303 to $7,483) for grade III, and $14,547 (95% CI: $6,334 to $22,760) for grade IV. The average postoperative cost for the patients who eventually died was $17,695 (95% CI: $11,246 to $24,144). Linear regression analysis showed that a prolonged length of hospital stay (p < 0.0001) and an unplanned admission to the intensive care unit (p < 0.0001) were significantly associated with postoperative costs in patients with major complications.
  
  
  CONCLUSIONS
  The severity of complications graded by the TMM system was associated with increasing postoperative costs. This instrument may be used to adjust lung resection reimbursement tariffs.
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom. Electronic address: brunellialex@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom.
authors.forename: Polyvios
authors.initials: P
authors.lastname: Drosos
authors.affiliation: Department of Oncology, Leeds Teaching Hospital National Health Service (NHS) Trust, Leeds, United Kingdom.
authors.forename: Padma
authors.initials: P
authors.lastname: Dinesh
authors.affiliation: Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Haaris
authors.initials: H
authors.lastname: Ismail
authors.affiliation: Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: Vinod
authors.initials: V
authors.lastname: Bassi
mesh_terms: D000368:Aged; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011182:Postoperative Care / Q000191:economics*; D011183:Postoperative Complications / Q000145:classification / Q000191:economics*; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted; D006113:United Kingdom