The influence of complications on the costs of complex cancer surgery

Authors

  • Marah N. Short MA,

    Corresponding author
    1. James A. Baker III Institute for Public Policy, Rice University, Houston, Texas
    • Corresponding author: Marah N. Short, MA, James A. Baker III Institute for Public Policy, Rice University, 6100 Main Street-MS 40, Houston, TX 77005-1827; Fax: (713) 348-5993; mnshort@rice.edu

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  • Thomas A. Aloia MD,

    1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Vivian Ho PhD

    1. James A. Baker III Institute for Public Policy, Rice University, Houston, Texas
    2. Department of Economics, Rice University, Houston, Texas
    3. Department of Medicine, Baylor College of Medicine, Houston, Texas
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Abstract

BACKGROUND

It is widely known that outcomes after cancer surgery vary widely, depending on interactions between patient, tumor, neoadjuvant therapy, and provider factors. Within this complex milieu, the influence of complications on the cost of surgical oncology care remains unknown. The authors examined rates of Patient Safety Indicator (PSI) occurrence for 6 cancer operations and their association with costs of care.

METHODS

The Agency for Healthcare Research and Quality (AHRQ) PSI definitions were used to identify patient safety-related complications in Medicare claims data. Hospital and inpatient physician claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Risk-adjusted regression analyses were used to measure the association between each PSI and hospitalization costs.

RESULTS

Overall PSI rates ranged from a low of 0.01% for postoperative hip fracture to a high of 2.58% for respiratory failure. Death among inpatients with serious treatable complications, postoperative respiratory failure, postoperative thromboembolism, and accidental puncture/laceration were >1% for all 6 cancer operations. Several PSIs—including decubitus ulcer, death among surgical inpatients with serious treatable complications, and postoperative thromboembolism—raised hospitalization costs by ≥20% for most cancer surgery types. Postoperative respiratory failure resulted in a cost increase >50% for all cancer resections.

CONCLUSIONS

The consistently higher costs associated with cancer surgery PSIs indicate that substantial health care savings could be achieved by targeting these indicators for quality improvement. Cancer 2014;120:1035–1041. © 2013 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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