The Cost of Complications Following Major Resection of Malignant Neoplasia

Cheryl K. Zogg, Taylor D. Ottesen, Kareem J. Kebaish, Anoop Galivanche, Shilpa Murthy, Navin R. Changoor, Donald L. Zogg, Timothy M. Pawlik, Adil H. Haider

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: Rising healthcare costs have led to increased focus on the need to achieve a higher “value of care.” As value-maximization efforts expand to include more complex surgical patients, evidence to support meaningful implementation of complication-based initiatives is lacking. The objective of this study was to compare incremental costs of complications following major gastrointestinal (GI) resections for organ-specific malignant neoplasia using nationally representative data. Methods: National (Nationwide) Inpatient Sample data, 2001–2014, were queried for adult (≥ 18 years) patients undergoing major resections for malignant neoplasia. Based on system-based complications considered relevant to the long-term treatment of GI disease, stratified differences in risk-adjusted incremental hospital costs and complication probabilities were compared. Differences in surgical outcomes and costs over time were also assessed. Results: A total of 293,967 patients were included, weighted to represent 1,408,117 patients nationwide. One fourth (26.1%; 95% CI, 25.7–26.4%) experienced ≥ 1 pre-discharge complication (range, 45.3% esophagectomy to 24.0% rectal resection). Resultant annual risk-adjusted incremental hospital costs totaled $540 million nationwide (19.5% of the overall cost of care and an average of $20,900 per patient). Costs varied substantially with both cancer/resection type and complication group, ranging from $76.7 million for colectomies with infectious complications to $0.2 million for rectal resections with urinary complications. For each resection type, infectious ($154.7 million), GI ($85.5 million), and pulmonary ($77.9 million) complications were among the most significant drivers of increased hospital cost. Conclusions: Quantifying and comparing the impact of complications on an indication-specific level in more complex patients offers an important step toward allowing providers/payers to meaningfully prioritize the design of novel and adaptation of existing value-maximization approaches.

Original languageEnglish
Pages (from-to)1976-1986
Number of pages11
JournalJournal of Gastrointestinal Surgery
Issue number11
Publication statusPublished - 1 Nov 2018
Externally publishedYes


  • Cancer
  • Complication
  • Cost
  • Infection
  • Oncology
  • Quality
  • Value


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