Johnston Samuel A, Louis Maleck, Churilov Leonid, Ma Ronald, Marhoon Nada, Bui Andrew, Christophi Christopher, Weinberg Laurence
University of Melbourne, Parkville.
Department of Anesthesia.
Medicine (Baltimore). 2020 May;99(19):e20089. doi: 10.1097/MD.0000000000020089.
To investigate the costs associated with postoperative complications following rectal resection.Rectal resection is a major surgical procedure that carries a significant risk of complications. The occurrence of complications following surgery has both health and financial consequences. There are very few studies that examine the incidence and severity of complications and their financial implications following rectal resection.We identified 381 consecutive patients who underwent a rectal resection within a major university hospital. Patients were included using the International Classification of Diseases (ICD) codes. Complications in the postoperative period were reported using the validated Clavien-Dindo classification system. Both the number and severity of complications were recorded. Activity-based costing methodology was used to report financial outcomes. Preoperative results were also recorded and assessed.A 76.9% [95% CI: 68.3:86.2] of patients experienced one or more complications. Patients who had a complication had a median total cost of $22,567 [IQR 16,607:33,641]. Patients who did not have a complication had a median total cost of $15,882 [IQR 12,971:19,861]. The adjusted additional median cost for patients who had a complication was $5308 [95% CI: 2938:7678] (P < .001). Patients who experienced a complication tended to undergo an open procedure (P = .001), were emergent patients (P = .003), preoperatively had lower albumin levels (36 vs 38, P = .0003) and were anemic (P = .001).Complications following rectal resection are common and are associated with increased costs. Our study highlights the importance of evaluating and preventing complications in the postoperative period.
为调查直肠切除术后并发症的相关费用。直肠切除是一项重大手术，具有较高的并发症风险。术后并发症的发生对健康和经济都有影响。很少有研究探讨直肠切除术后并发症的发生率、严重程度及其经济影响。我们确定了一所大型大学医院中连续接受直肠切除手术的381例患者。使用国际疾病分类（ICD）编码纳入患者。术后并发症采用经过验证的Clavien-Dindo分类系统进行报告。记录并发症的数量和严重程度。采用作业成本法报告财务结果。还记录并评估术前结果。76.9%[95%CI：68.3:86.2]的患者发生了一种或多种并发症。发生并发症的患者总费用中位数为22,567美元[四分位间距16,607:33,641]。未发生并发症的患者总费用中位数为15,882美元[四分位间距12,971:19,861]。发生并发症的患者调整后的额外费用中位数为5308美元[95%CI：2938:7678]（P<0.001）。发生并发症的患者倾向于接受开放手术（P=0.001），为急诊患者（P=0.003），术前白蛋白水平较低（36对38，P=0.0003）且贫血（P=0.001）。直肠切除术后并发症很常见，且与费用增加相关。我们的研究强调了评估和预防术后并发症的重要性。
