Association of hospital costs with complications following total gastrectomy for gastric adenocarcinoma Journal Article


Authors: Selby, L. V.; Gennarelli, R. L.; Schnorr, G. C.; Solomon, S. B.; Schattner, M. A.; Elkin, E. B.; Bach, P. B.; Strong, V. E.
Article Title: Association of hospital costs with complications following total gastrectomy for gastric adenocarcinoma
Abstract: IMPORTANCE: Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. OBJECTIVE: To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. DESIGN, SETTING, AND PARTICIPANTS: This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. MAINOUTCOMESANDMEASURES: Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. RESULTS: In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing tothe cost of surgical care (mean [SD] cost,MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized costof MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost,MP $11 940 [MP $8820]), consultations (mean [SD] cost, MP $3530 [MP $2410]), and intensive care unit care (mean [SD] cost, MP $7770 [MP $14 310]). CONCLUSIONS AND RELEVANCE: Major complications were associated with tripled normalized costs following curative-intent total gastrectomy. Most of the excess costs were related to the treatment of complications. Interventions that decrease the number or severity of postoperative complications could result in substantial cost savings. © 2017 American Medical Association. All rights reserved.
Keywords: adult; controlled study; treatment outcome; aged; middle aged; cancer surgery; retrospective studies; major clinical study; cancer staging; follow up; adenocarcinoma; pathology; retrospective study; postoperative complication; postoperative complications; medicare; reimbursement; economics; cancer center; intensive care unit; hospitalization; cancer care facilities; gastrectomy; hospital patient; outpatient; consultation; hospital readmission; stomach adenocarcinoma; stomach neoplasms; hospital cost; hospital costs; total stomach resection; accounting; humans; human; male; female; priority journal; article
Journal Title: JAMA Surgery
Volume: 152
Issue: 10
ISSN: 2168-6254
Publisher: American Medical Association  
Date Published: 2017-10-01
Start Page: 953
End Page: 958
Language: English
DOI: 10.1001/jamasurg.2017.1718
PUBMED: 28658485
PROVIDER: scopus
PMCID: PMC5710284
DOI/URL:
Notes: Article -- Export Date: 4 December 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Elena B Elkin
    151 Elkin
  2. Peter Bach
    202 Bach
  3. Stephen Solomon
    267 Solomon
  4. Vivian Strong
    148 Strong
  5. Mark Schattner
    103 Schattner
  6. Luke   Selby
    19 Selby