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.
Keywords
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Article info
Publication history
Published online: December 05, 2016
Accepted:
November 21,
2016
Identification
Copyright
© 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
