TY - JOUR
T1 - Postoperative complications and hospital costs following open radical cystectomy
T2 - A retrospective study
AU - Weinberg, Laurence
AU - Aitken, Sarah Aishah Azlina
AU - Kaldas, Peter
AU - Fletcher, Luke
AU - Lloyd-Donald, Patryck
AU - Le, Peter
AU - Do, Daniel
AU - Caruana, Carla Borg
AU - Walpole, Dominic
AU - Ischia, Joseph
AU - Ma, Ronald
AU - Tan, Chong Oon
AU - Lee, Dong Kyu
N1 - Publisher Copyright:
Copyright: © 2023 Weinberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2023/2
Y1 - 2023/2
N2 - Objectives To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy. Methods Postoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien–Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model. Results 135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9–53,532.5) and $81,050.1 (49,614.8–122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%–76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%–181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08–1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23–5.07) respectively. Conclusions These findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies.
AB - Objectives To evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy. Methods Postoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien–Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model. Results 135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9–53,532.5) and $81,050.1 (49,614.8–122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%–76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%–181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08–1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23–5.07) respectively. Conclusions These findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies.
UR - http://www.scopus.com/inward/record.url?scp=85148908622&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0282324
DO - 10.1371/journal.pone.0282324
M3 - Article
C2 - 36827411
AN - SCOPUS:85148908622
SN - 1932-6203
VL - 18
JO - PLoS ONE
JF - PLoS ONE
IS - 2 February
M1 - e0282324
ER -