A. Larentzakis2, M. Mavros3, E. P. Ramly1, Y. Chang1, G. Velmahos1, J. Lee1, D. Yeh1, H. Kaafarani1 1Massachusetts General Hospital,Trauma, Emergency Surgery And Surgical Critical Care,Boston, MA, USA 2University Of Manchester,General Surgery,Manchester, , United Kingdom 3Washington Hospital Center,General Surgery,Washington, DC, USA
Introduction:
Little evidence currently exists regarding the impact of intraoperative adverse events (iAEs) on healthcare costs. With the hypothesis that iAEs independently increase healthcare costs and patient charges, we retrospectively evaluated the ACS-NSQIP cohort of patients treated at our tertiary academic center.
Methods:
The administrative and ACS-NSQIP databases were carefully matched for all patients having undergone general surgery. The ICD-9-CM based Patient Safety Indicator “Accidental Puncture/Laceration” was used to screen the matched database for iAEs. All iAEs were then confirmed using a standardized review of operative reports. The preoperative, intraoperative and postoperative ACS-NSQIP data variables were supplemented with cost variables including total, direct, indirect, operating room (OR), laboratory, radiology, nutrition and medical therapy charges. Multivariate analyses were performed to study the increased cost in healthcare charges that can be independently attributed to the occurrence of an iAE.
Results:
Our patient population included 9111 patients, 183 of which were confirmed to have had iAEs. Multivariate analyses controlling for demographics, preoperative co-morbidities/laboratory values, type/approach of surgery, operative complexity (measured in relative value units) and relevant intraoperative factors demonstrated that iAEs independently increased the total admission charges by 41% [95%CI: 30%-52%] (P<0.001). Specifically, the direct, indirect, OR, laboratory, radiology, alimentation and medical therapy charges all increased in the range of 27 to 54% (p<0.001; Table 1).
Conclusion:
In addition to the morbidity incurred by patients, the occurrence of an iAE is associated with major financial costs to the patient and the healthcare system.
