Skip to main content
Log in

Association of postoperative complications with hospital costs and length of stay in a tertiary care center

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: Postoperative complications are a significant source of morbidity and mortality. There are limited studies, however, assessing the impact of common postoperative complications on health care resource utilization.

OBJECTIVE: To assess the association of clinically important postoperative complications with total hospital costs and length of stay (LOS) in patients undergoing noncardiac surgery.

METHODS: We determined total hospital costs and LOS in all patients admitted to a single tertiary care center between July 1, 1996 and March 31, 1998 using a detailed administrative hospital discharge database. Total hospital costs and LOS were adjusted for preoperative and surgical characteristics.

RESULTS: Of 7,457 patients who underwent noncardiac surgery, 6.9% developed at least 1 of the postoperative complications. These complications increased hospital costs by 78% (95% confidence interval [CI]: 68% to 90%) and LOS by 114% (95% CI: 100% to 130%) after adjustment for patient preoperative and surgical characteristics. Postoperative pneumonia was the most common complication (3%) and was associated with a 55% increase in hospital costs (95% CI: 42% to 69%) and an 89% increase in LOS (95% CI: 70% to 109%).

CONCLUSIONS: Postoperative complications consume considerable health care resources. Initiatives targeting prevention of these events could significantly reduce overall costs of care and improve patient quality of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Weingart SN, Iezzoni LI, Davis RB, et al. Use of administrative data to find substandard care: validation of the complications screening program. Med Care. 2000;38:796–806.

    Article  CAS  PubMed  Google Scholar 

  2. Fleischmann KE, Goldman L, Young B, Lee TH. Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med. 2003;115:515–20.

    Article  PubMed  Google Scholar 

  3. Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA Jr. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199:531–7.

    Article  PubMed  Google Scholar 

  4. Naglie G, Tansey C, Krahn MD, O’Rourke K, Detsky AS, Bolley H. Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65. CMAJ. 1999;160:805–11.

    CAS  PubMed  Google Scholar 

  5. Keon WJ, Menzies SC, Lay CM. Cost of coronary artery bypass surgery: a pilot study. Can J Surg. 1985;28:283–6.

    CAS  PubMed  Google Scholar 

  6. Krueger H, Goncalves JL, Caruth FM, Hayden RI. Coronary artery bypass grafting: how much does it cost? CMAJ. 1992;146:63–8.

    Google Scholar 

  7. Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. Chest. 1996;110:744–50.

    Article  CAS  PubMed  Google Scholar 

  8. Kalish RL, Daley J, Duncan CC, Davis RB, Coffman GA, Iezzoni LI. Costs of potential complications of care for major surgery patients. Am J Med Quality. 1995;10:48–54.

    Article  CAS  Google Scholar 

  9. Naessens JM, Huschka TR. Distinguishing hospital complications of care from pre-existing conditions. Int J Qual Health Care. 2004;16(suppl 1):i27–35.

    Article  PubMed  Google Scholar 

  10. U.S. Department of Health and Human Services. International Classification of Diseases, 9th revision (Clinical Modification). Washington, DC: Public Health Service, U.S. Department of Health and Human Services; 1998.

    Google Scholar 

  11. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.

    Article  CAS  PubMed  Google Scholar 

  12. Southern DA, Quan H, Ghali WA. Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Med Care. 2004;42:355–60.

    Article  PubMed  Google Scholar 

  13. Quan H, Parsons GA, Ghali WA. Assessing accuracy of diagnosis-type indicators for flagging complications in administrative data. J Clin Epidemiol. 2004;57:366–72.

    Article  PubMed  Google Scholar 

  14. Bugar JM, Ghali WA, Lemaire JB, Quan H. Canadian Perioperative Research Network. Utilization of a preoperative assessment clinic in a tertiary care centre. Clin Invest Med. 2002;25:11–8.

    PubMed  Google Scholar 

  15. McCarthy EP, Iezzoni LI, Davis RB, et al. Does clinical evidence support ICD-9-CM diagnosis coding of complications? Med Care. 2000;38:868–76.

    Article  CAS  PubMed  Google Scholar 

  16. Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH, Iezzoni LI. Identification of in-hospital complications from claims data. Is it valid? Med Care. 2000;38:785–95.

    Article  CAS  PubMed  Google Scholar 

  17. Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg. 1999;230:251–9.

    Article  CAS  PubMed  Google Scholar 

  18. McAlister FA, Khan NA, Straus SE, et al. Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med. 2003;167:741–4.

    Article  PubMed  Google Scholar 

  19. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    CAS  PubMed  Google Scholar 

  20. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290:1868–74.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nadia A. Khan MD, MSc.

Additional information

The authors have no conflicts of interest to declare for this paper.

Dr. Khan is funded by Canadian Institutes of Health Research (CIHR) and Michael Smith Foundation for Health Research postdoctoral fellowship awards. Dr. Khan also received postdoctoral fellowship funding from the Alberta Heritage Foundation for Medical Research (AHFMR) during the analysis of this data. Dr. Ghali is funded by AHFMR as a Scholar and holds a Canada Research Chair. Dr. Hude Quan is funded by CIHR as New Investigator and AHFMR as a Population Health Investigator.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Khan, N.A., Quan, H., Bugar, J.M. et al. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med 21, 177–180 (2006). https://doi.org/10.1007/s11606-006-0254-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-006-0254-1

Key words

Navigation