Original article
General thoracic
What Is the Inpatient Cost of Hospital Complications or Death After Lobectomy or Pneumonectomy?

https://doi.org/10.1016/j.athoracsur.2010.08.043Get rights and content

Background

No information exists evaluating the costs of complications or death after lobectomy or pneumonectomy.

Methods

We analyzed hospital costs for 294 patients who underwent lobectomy (n = 268) or pneumonectomy (n = 26) from January 2005 through September 2007. The patients were categorized into two groups on the basis of clinical outcomes: uncomplicated versus complications or death. A cost prediction model was constructed with linear regression using uncomplicated patients only. The model was applied to the complications or death group to predict the expected cost as if they had no complication. The risk-adjusted cost of complications or death was quantified by the difference between the observed cost and the expected cost.

Results

There were 241 patients in the uncomplicated group (19 pneumonectomy), and 53 patients had complications or death (7 pneumonectomy). Length of stay was shorter for uncomplicated versus complications or death for both lobectomy and pneumonectomy. Pneumonectomy was costlier than lobectomy. Experiencing complications or death was costlier than costs associated with uncomplicated cases. The actual cost for uncomplicated cases was $18,380. The expected cost for complications or death was similar to that for uncomplicated cases regardless of the number of complications or death. The mean risk-adjusted cost of complications (95% confidence interval) increased by the number of complications: $11,693 ($4,430 to $18,957), $26,673 ($12,320 to $41,025) and $128,450 ($93,971 to $162,930) for 1, 2, and 3 complications, respectively. It was $49,823 ($23,187 to $76,459) for death.

Conclusions

Patients experiencing complications or death have a similar perioperative risk profile as patients without complications. Hospital death or postoperative complications after lobectomy or pneumonectomy are economically costly. Decreasing inpatient death or complications would result in substantial cost-of-care savings.

Section snippets

Clinical Data

Since 2004, the Providence Thoracic Surgery Program (TSP) has functioned within a large health system not affiliated with a university involving competing private practice surgical groups in two tertiary-care hospitals in a major metropolitan area (Providence Health and Services, Portland, OR). All surgeons performing any amount of thoracic surgery within general or cardiothoracic surgery groups and participating in multidisciplinary care are members of the TSP. A dedicated TSP data manager

Results

During 33 months, 294 anatomic resections were performed consisting of 268 lobectomies (lobectomy 229, sleeve 8, bilobectomy 20, segmentectomy 11) and 26 pneumonectomies (standard 13, carinal 1, completion 3, extrapleural 4, intrapericardial 5). Cardiothoracic surgeons performed 244 lobectomies and 24 pneumonectomies, and general surgeons performed 24 lobectomies and 2 pneumonectomies.

Table 1 displays common clinical characteristics contributing to thoracic surgery mortality risk [7, 8] for the

Comment

Cost of medical care has long been subjected to scrutiny with attempts to understand the components and drivers, thus enabling potential control of costs [1]. Most reports on cost of surgical care are actually based on charge data variously manipulated to derive cost inference [3, 9, 10].

The potential drivers of cost differences are complex. Do costs reflect more complex care as a result of patient characteristics (our lobectomy patients experiencing complications or death were older with worse

References (28)

Cited by (0)

View full text