• Sean M Stokes, Courtney L Scaife, Benjamin S Brooke, Robert E Glasgow, Sean J Mulvihill, FinlaysonSamuel R GSRG, and Thomas K Varghese.
• Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
• Ann. Surg. 2022 Feb 1; 275 (2): e375e381e375-e381.

ObjectiveSurgical complications have substantial impact on healthcare costs. We propose an analysis of the financial impact of postoperative complications.Summary Of Background DataBoth complications and preoperative patient risk have been shown to increase costs following surgery. The extent of cost increase due to specific complications has not been well described.MethodsA single institution's American College of Surgeons National Surgical Quality Improvement Program data was queried from 2012 to 2018 and merged with institutional cost data for each encounter. A mixed effects multivariable generalized linear model was used to estimate the mean relative increase in hospital cost due to each complication, adjusting for patient and procedure-level fixed effects clustered by procedure. Potential savings were calculated based on projected decreases in complication rates and theoretical hospital volume.ResultsThere were 11,897 patients linked between the 2 databases. The rate of any American College of Surgeons National Surgical Quality Improvement Program complication was 11.7%. The occurrence of any complication resulted in a 1.5-fold mean increase in direct hospital cost [95% confidence interval (CI) 1.49-1.58]. The top 6 most costly complications were postoperative septic shock (4.0-fold, 95% CI 3.58-4.43) renal insufficiency/failure (3.3-fold, 95% CI 2.91-3.65), any respiratory complication (3.1-fold, 95% CI 2.94-3.36), cardiac arrest (3.0-fold, 95% CI 2.64-3.46), myocardial infarction (2.9-fold, 95% CI 2.43-3.42) and mortality within 30 days (2.2-fold, 95% CI 2.01-2.48). Length of stay (6.5 versus 3.2 days, P < 0.01), readmission rate (29.1% vs 3.1%, P < 0.01), and discharge destination outside of home (20.5% vs 2.7%, P < 0.01) were significantly higher in the population who experienced complications.ConclusionsDecreasing complication rates through preoperative optimization will improve patient outcomes and lead to substantial cost savings.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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