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.
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.
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).
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Surgical Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Global cancer statistics, 2012.CA Cancer J Clin. 2015; 65: 87-108
- Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis.Lancet Oncol. 2011; 12: 681-692
- Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial.Lancet Oncol. 2015; 16: 1090-1098
- Preoperative chemoradiotherapy for esophageal or junctional cancer.N Engl J Med. 2012; 366: 2074-2084
- Esophagectomy–it's not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer.J Gastrointest Surg. 2007; 11 (discussion 1402): 1395-1402
- The impact of postoperative complications on survivals after esophagectomy for esophageal cancer.Medicine (Baltimore). 2015; 94: e1369
- Value-based cancer care.N Engl J Med. 2015; 373: 2593-2595
- What is value in health care?.N Engl J Med. 2010; 363: 2477-2481
- Reporting of short-term clinical outcomes after esophagectomy: a systematic review.Ann Surg. 2012; 255: 658-666
- The influence of complications on the costs of complex cancer surgery.Cancer. 2014; 120: 1035-1041
- Complications and costs after high-risk surgery: where should we focus quality improvement initiatives?.J Am Coll Surg. 2003; 196: 671-678
- Early outcomes from the Dutch upper gastrointestinal cancer audit.Br J Surg. 2016 Dec; 103: 1855-1863
- End-to-end cervical esophagogastric anastomoses are associated with a higher number of strictures compared with end-to-side anastomoses.J Gastrointest Surg. 2013; 17: 872-876
- The clavien-dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Time-driven activity-based costing.Harv Bus Rev. 2004; 82 (131,138, 150)
- Readmission predicts 90-day mortality after esophagectomy: analysis of surveillance, epidemiology, and end results registry linked to medicare outcomes.J Thorac Cardiovasc Surg. 2015; 150: 1254-1260
- Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a european multicenter study.Ann Surg. 2014; 260 (764,770; discussion 770–1)
- Costs of complications after colorectal cancer surgery in the Netherlands: building the business case for hospitals.Eur J Surg Oncol. 2015; 41: 1059-1067
- The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients.Ann Surg. 2011; 254: 907-913
- Hospital cost-analysis of complications after major abdominal surgery.Dig Surg. 2015; 32: 150-156
- Accordion severity grading system: assessment of relationship between costs, length of hospital stay, and survival in patients with complications after esophagectomy for cancer.J Am Coll Surg. 2012; 215: 331-336
- Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis.Ann Surg. 2011; 254: 894-906
- Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: a value-based comparison.J Surg Oncol. 2015; 112: 517-523
- Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database.Ann Thorac Surg. 2013; 96: 1919-1926
- Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: a case study using the national surgical quality improvement program (NSQIP) database.Ann Surg. 2005; 242 (463,468; discussion 468–71)
- Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study.Int Surg. 2012; 97: 198-202
- Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study.Ann Surg Oncol. 2014; 21: 2353-2360
- Impact of preoperative risk factors on morbidity after esophagectomy: is there room for improvement?.World J Surg. 2014; 38: 2882-2890
- Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care.Br J Surg. 2004; 91: 983-990
- Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery.BMJ. 1999; 318: 1099-1103
- Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways.Reg Anesth Pain Med. 2011; 36: 63-72
- Aortic calcification increases the risk of anastomotic leakage after ivor-lewis esophagectomy.Ann Thorac Surg. 2016; 102: 247-252
- Ischemic conditioning of the stomach in the prevention of esophagogastric anastomotic leakage after esophagectomy.Ann Thorac Surg. 2016; 101: 1614-1623
- Nationwide outcomes measurement in colorectal cancer surgery: improving quality and reducing costs.J Am Coll Surg. 2016; 222: 19,29.e2
- A new clinical scoring system to define pneumonia following esophagectomy for cancer.Dig Surg. 2014; 31: 108-116
Published online: December 05, 2016
Accepted: November 21, 2016
© 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.