Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, 7-3-1 University of Tokyo Hospital Chuoushinryoutou II, 8F, Hongo, Tokyo, 113-8655, Japan.
Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan.
Surg Today. 2022 Dec;52(12):1766-1774. doi: 10.1007/s00595-022-02523-6. Epub 2022 May 24.
To assess the increase in hospital costs associated with postoperative complications after lower anterior resection (LAR) for rectal cancer.
The subjects of this retrospective analysis were patients who underwent elective LAR surgery between April, 2015 and March, 2017, collected from a Japanese nationwide gastroenterological surgery registry linked to hospital-based claims data. We evaluated total and category-specific hospitalization costs based on the level of postoperative complications categorized using the Clavien-Dindo (CD) classification. We assessed the relative increase in hospital costs, adjusting for preoperative factors and hospital case volume.
We identified 15,187 patients (mean age 66.8) treated at 884 hospitals. Overall, 71.8% had no recorded complications, whereas 7.6%, 10.8%, 9.0%, 0.6%, and 0.2% had postoperative complications of CD grades I-V, respectively. The median (25th-75th percentiles) hospital costs were $17.3 K (16.1-19.3) for the no-complications group, and $19.1 K (17.3-22.2), $21.0 K (18.5-25.0), $27.4 K (22.4-33.9), $41.8 K (291-618), and $22.7 K (183-421) for the CD grades I-V complication groups, respectively. The multivariable model identified that complications of CD grades I-V were associated with 11%, 21%, 61%, 142%, and 70% increases in in-hospital costs compared with no complications.
Postoperative complications and their severity are strongly associated with increased hospital costs and health-care resource utilization. Implementing strategies to prevent postoperative complications will improve patients' clinical outcomes and reduce hospital care costs substantially.
评估直肠癌低位前切除术（LAR）术后并发症相关的住院费用增加。
本回顾性分析的对象为 2015 年 4 月至 2017 年 3 月期间，从与医院索赔数据相关联的日本全国胃肠外科手术登记处收集的接受择期 LAR 手术的患者。我们根据术后并发症的严重程度，采用 Clavien-Dindo（CD）分类法，评估了总住院费用和分类住院费用。我们评估了在调整术前因素和医院病例量后，住院费用的相对增加。
我们共纳入 15187 例患者（平均年龄 66.8 岁），他们在 884 家医院接受治疗。总体而言，71.8%的患者无记录并发症，7.6%、10.8%、9.0%、0.6%和 0.2%的患者分别有 CD 分级 I-V 级的术后并发症。无并发症组的中位（25 至 75 百分位数）住院费用为 17.3 千美元（16.1-19.3），CD 分级 I-V 并发症组的住院费用分别为 19.1 千美元（17.3-22.2）、21.0 千美元（18.5-25.0）、27.4 千美元（22.4-33.9）、41.8 千美元（291-618）和 22.7 千美元（183-421）。多变量模型发现，与无并发症相比，CD 分级 I-V 并发症与住院费用增加 11%、21%、61%、142%和 70%相关。
术后并发症及其严重程度与住院费用增加和医疗资源利用增加密切相关。实施预防术后并发症的策略将显著改善患者的临床结局并降低医院护理成本。
