Impact of processes of care aimed at complication reduction on the cost of complex cancer surgery
Author
Short, Marah N.; Ho, Vivian; Aloia, Thomas A.
Date
2015Abstract
Background and Objectives: Health care providers add multiple processes to the care of complex cancer patients, believing they prevent and/or ameliorate complications. However, the relationship between these processes, complication remediation, and expenditures is unknown. Methods: Data for patients with cancer diagnoses undergoing colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection were obtained from hospital and inpatient physician Medicare claims for the years 2005 to 2009. Risk-adjusted regression analyses measured the association between hospitalization costs and processes presumed to prevent and/or remedy complications common to high-risk procedures. Results: After controlling for comorbidities, analysis identified associations between increased costs and the use of multiple processes, including arterial lines (4-12% higher; p<0.001), central venous catheters (11-22% higher; p<0.001) and pulmonary artery catheters (23-33% higher; p<0.001). Epidural analgesia was not associated with higher costs. Consultations were associated with 24-44% (p<0.001) higher costs, and total parenteral nutrition was associated with 13-31% higher costs for multiple procedures (p<0.001) Conclusions: Many frequently utilized processes and services presumed to avoid and/or ameliorate complications are associated with increased surgical oncology costs. This suggests that the patient-centered value of each process should be measured on a procedure-specific basis. Likewise, further attention should be focused on defining the efficacy of each of these costly, but frequently unproven, additions to perioperative care.
Citation
Published Version
Keyword
cancer; cost analysis; surgery; process of care
Type
Journal article
Publisher
Citable link to this page
https://hdl.handle.net/1911/87839Rights
This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by Wiley.Metadata
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