Economic Cost Analysis Related to Complications in General and Digestive Surgery

Received 07 September 2017. Accepted 13 February 2018

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Tables (6)

Table 1. Economic Costs and Indicators.

Table 2. Analysis of the Types of Complications Versus Their Absence.

Table 3. Other Variables Caused by the Presence of Complications: Distribution of Frequencies.

Table 4. Non-Parametric Analysis of Mean Hospital Stay, Cost and Differential Cost According to the Complication Severity Grade.

Table 5. Analysis of Mean Hospital Stay, Cost and Differential Cost According to Date of Admission During Vacation Periods.

Table 6. Multivariate Linear Regression Models and Regression Equations for Global Hospital Stay and Economic Costs.

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Abstract

Introduction

The aim was to assess the impact on economic costs and length of stay (LOS) of postoperative complications.

Methods

5822 records from BMDS (2014–2015) are included. A descriptive, univariate and multivariate study evaluated the correlation between complications, Clavien-Dindo grade and vacation periods with LOS and economic costs, based on a full-cost model, aggregated by DRG.

Results and conclusions

Mean cost per stay was €676.71, and €4309.02 per episode. Complications appeared in 639 patients (11%). Admission to ICU was required in 203 patients, re-operation in 134 and re-admission in 243, while 66 patients died (1.1%). Complications caused significantly longer LOS (20.08 vs 5.48 days) and higher economic cost (€11670.31 vs €3354.12); infectious complications were the most frequent and respiratory the most expensive (€20428.53), together with ICU admission (€20242.66). Clavien-Dindo grade correlated with greater LOS and costs (except grade V). During vacation periods, complications and LOS are increased, but costs of these complications and LOS did not differ significantly from complications detected in non-vacation periods.

Keywords:

Postoperative complications

General surgery

Costs and cost-analysis

Public hospital

Resumen

Introducción

El objetivo es analizar el impacto en costes económicos y estancias de las complicaciones quirúrgicas.

Métodos

Incluimos 5.822 registros del CMBD (2014-2015). Realizamos análisis descriptivo, univariante y multivariante, evaluando asociación entre complicaciones, grado Clavien-Dindo y vacaciones con estancias y costes económicos (modelo de costes totales agregados por GRD).

Resultados y conclusiones

El coste medio por estancia es de 676,71€, y de 4.309,02€ por episodio. Presentaron complicación 639 (11%). 203 ingresos en UCI, 134 reintervenciones, 243 reingresos y 66 fallecimientos (1,1%). Las complicaciones generan mayor estancia (20,08 vs 5,48 días) y coste (11.670,31€ vs 3.354,12€), siendo las infecciosas las más frecuentes y las respiratorias las más costosas (20.428,53€), conjuntamente con ingreso en UCI. El grado de Clavien-Dindo se correlaciona con el incremento de estancias y costes (excepto grado v). En vacaciones aumentan complicaciones y estancias, pero sus costes no varían respecto a no vacaciones.

Palabras clave:

Complicaciones postoperatorias

Cirugía general

Costos y análisis de costo

Hospitales públicos