Evaluating the validity of the Clavien-Dindo classification in colectomy studies: A 90-day cost of care analysis Journal Article
| Authors: | Widmar, M.; Keskin, M.; Strombom, P. D.; Gennarelli, R. L.; Szeglin, B. C.; Smith, J. J.; Nash, G. M.; Weiser, M. R.; Paty, P. B.; Russell, D.; Garcia-Aguilar, J. |
| Article Title: | Evaluating the validity of the Clavien-Dindo classification in colectomy studies: A 90-day cost of care analysis |
| Abstract: | BACKGROUND: The Clavien-Dindo classification is widely used to report postoperative morbidity but may underestimate the severity of colectomy complications. OBJECTIVE: The purpose of this study was to assess how well the Clavien-Dindo classification represents the severity of all grades of complications after colectomy using cost of care modeling. DESIGN: This was a retrospective cohort study. SETTINGS: The study was conducted at a comprehensive cancer center. PATIENTS: Consecutive patients (N = 1807) undergoing elective colon or rectal resections without a stoma performed at Memorial Sloan Kettering Cancer Center between 2009 and 2014 who were followed up for >= 90 days, were not transferred to other hospitals, and did not receive intraperitoneal chemotherapy were included in the study. MAIN OUTCOME MEASURES: Complication severity was measured by the highest-grade complication per patient and attributable outpatient and inpatient costs. Associations were evaluated between patient complication grade and cost during 3 time periods: the 90 days after surgery, index admission, and postdischarge (<90 d). RESULTS: Of the 1807 patients (median age = 62 y), 779 (43%) had a complication; 80% of these patients had only grade 1 or 2 complications. Increasing patient complication grade correlated with 90-day cost, driven by inpatient cost differences (p < 0.001). For grade 1 and 2 patients, most costs were incurred after discharge and were the same between these grade categories. Among patients with a single complication (52%), there was no difference in index hospitalization, postdischarge, or total 90-day costs between grade 1 and 2 categories. LIMITATIONS: The study was limited by its retrospective design and generalizability. CONCLUSIONS: The Clavien-Dindo classification correlates well with 90-day costs, driven largely by inpatient resource use. Clavien-Dindo does not discriminate well among patients with low-grade complications in terms of their substantial postdischarge costs. These patients represent 80% of patients with a complication after colectomy. Examining the long-term burden associated with complications can help refine the Clavien-Dindo classification for use in colectomy studies. See Video Abstract at http://links. lww.com/DCR/B521. |
| Keywords: | morbidity; surgery; complications; postoperative; colectomy; impact; quality; burden; severity grading system; clavien-dindo; cost of care; major surgical-procedures |
| Journal Title: | Diseases of the Colon and Rectum |
| Volume: | 64 |
| Issue: | 11 |
| ISSN: | 0012-3706 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2021-11-01 |
| Start Page: | 1426 |
| End Page: | 1434 |
| Language: | English |
| ACCESSION: | WOS:000705028700028 |
| DOI: | 10.1097/dcr.0000000000001966 |
| PROVIDER: | wos |
| PMCID: | PMC8502230 |
| PUBMED: | 34623350 |
| Notes: | Article -- Source: Wos |
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MSK Authors
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496Paty -
532Weiser -
261Nash -
345Garcia Aguilar -
217Smith -
74Widmar -
32Gennarelli -
10Keskin -
19
Strombom -
10
Szeglin
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