@article {413196,
	title = {Rethinking Priorities: Cost of Complications After Elective Colectomy.},
	journal = {Ann Surg},
	year = {2015},
	month = {2015 Oct 31},
	abstract = {OBJECTIVE: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses.

SUMMARY BACKGROUND DATA: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking.

METHODS: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (>=18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared.

RESULTS: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4\% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3\% was due to complications [1.9\% due to current Centers for Medicare and Medicaid Services (CMS) complications].

CONCLUSIONS: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.},
	issn = {1528-1140},
	doi = {10.1097/SLA.0000000000001511},
	author = {Zogg, Cheryl K and Najjar, Peter and Rios Diaz, Arturo J and Zogg, Donald L and Tsai, Thomas C. and Rose, John A and Scott, John W and Gani, Faiz and Alshaikh, Husain and Nagarajan, Neeraja and Canner, Joseph K and Schneider, Eric B and Goldberg, Joel E and Haider, Adil H}
}
