Study Assesses Excess Cost Associated with Post-Operative Complications among Veterans in VA Hospitals

BACKGROUND:
Post-operative complications have been found to be among the most frequent of inpatient adverse events, as well as the most costly, since complications following surgery can lead to increased days of hospitalization, greater intensity of services, more ancillary services, and/or extra medications. This observational study estimated excess costs associated with post-operative complications among inpatients treated in VA hospitals. Using VA data, investigators examined 43,822 hospitalizations among Veterans who had undergone inpatient surgery in one of 104 acute-care VA hospitals during FY07. The key independent variable was whether the Veteran had experienced any of 19 post-operative complications, which included: central nervous system complications (e.g., cardiac arrest, cerebral vascular accident/stroke); other surgical complications (e.g., deep vein thrombosis, systemic sepsis); respiratory complications (e.g., failure to wean >48 hours, pneumonia); urinary tract complications (e.g., acute renal failure, urinary tract infection); and wound complications (e.g., infection). Using measures obtained from chart abstraction from the VA National Surgical Quality Improvement Program, excess cost associated with the complication was calculated as the difference between the predicted cost with the complication and the predicted cost without the complication, after adjusting for other demographic factors and disease severity.

FINDINGS:

• Among Veterans who survived to discharge, excess costs associated with post-operative complications were found to be considerable. Veterans experiencing complications had inpatient costs that ranged from 3% to 120% higher (for “cardiac arrest requiring CPR” and “failure to wean,” respectively) than those without complications.
• Among the 16 complications that were significantly related to cost, the estimated excess costs ranged from $8,234 for “progressive renal insufficiency” to $28,779 for “failure to wean from ventilator within 48 hours.”

IMPLICATIONS:

• Results suggest that directing efforts toward reducing complications such as cerebral vascular accidents, sepsis, acute renal failure, and failure to wean, each of which incurred excess costs of greater than $20,000, might have high value.

LIMITATIONS:

• Excess costs that were measured were only those incurred during the inpatient stay.
• This is an observational study using data from a single year, so causality cannot be identified.

AUTHOR/FUNDING INFORMATION:
This study was funded through HSR&D (IIR 07-072). Drs. Carey, Zhao, and Borzecki are part of HSR&D’s Center for Health Quality, Outcomes and Economic Research, Bedford, MA; Dr. Rosen is part of HSR&D’s Center for Organization, Leadership and Management Research, Boston, MA.

Carey K, Stefos T, Zhao S, Borzecki A, and Rosen A. Excess Costs Attributable to Post-Operative Complications. Medical Care Research and Review August 2011;68(4):490-503.