Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2255-2269
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2255
Cost burden following esophagectomy: A single centre observational study
Vered Buchholz, Dong Kyu Lee, David S Liu, Ahmad Aly, Stephen A Barnett, Riley Hazard, Peter Le, Benjamin Kioussis, Vijayaragavan Muralidharan, Laurence Weinberg
Vered Buchholz, Department of Surgery, Austin Health, Melbourne 3084, Victoria, Australia
Dong Kyu Lee, Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Seoul 14566, Goyang, South Korea
David S Liu, Ahmad Aly, Stephen A Barnett, Vijayaragavan Muralidharan, Department of Surgery, Austin Health, The University of Melbourne, Melbourne 3084, Victoria, Australia
Riley Hazard, Peter Le, Benjamin Kioussis, Department of Anesthesia, Austin Health, Melbourne 3084, Victoria, Australia
Laurence Weinberg, Department of Anesthesia, Austin Hospital, Heidelberg 3084, Victoria, Australia
Laurence Weinberg, Department of Critical Care, The University of Melbourne, Melbourne 3084, Victoria, Australia
Author contributions: Buchholz V and Weinberg L designed the research study and wrote the paper; Lee DK analyzed the data; Liu DS, Aly A, Barnett SA, Hazard R, Kioussis B, Le P and Muralidharan V assisted with data collection and wrote the study; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Austin Health Human Research Ethics Committee, Approval No. Audit/19/Austin/103.
Informed consent statement: A waiver of participant consent was provided by the Austin Health Research Ethics Committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The full dataset is available as a Supplementary material.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Laurence Weinberg, BSc, MBChB, MD, MRCP, PhD, Director, Full Professor, Department of Anesthesia, Austin Hospital, 145 Studley Road, Heidelberg 3084, Victoria, Australia. laurence.weinberg@austin.org.au
Received: April 25, 2024
Revised: June 16, 2024
Accepted: July 1, 2024
Published online: July 27, 2024
Processing time: 88 Days and 1.7 Hours
Abstract
BACKGROUND

Cost analyses of patients undergoing esophagectomy is valuable for identifying modifiable expenditure drivers to target and curtail costs while improving the quality of care. We aimed to define the cost-complication relationship after esophagectomy and delineate the incremental contributions to costs.

AIM

To assess the relationship between the hospital costs and potential cost drivers post esophagectomy and investigate the relationship between the cost-driving variables (predicting variables) and hospital costs (dependent variable).

METHODS

In this retrospective single center study, the severity of complications was graded using the Clavien-Dindo (CD) classification system. Key esophagectomy complications were categorized and defined according to consensus guidelines. Raw costing data included the in-hospital costs of the index admission and any unplanned admission within 30 postoperative days. We used correlation analysis to assess the relationship between key clinical variables and hospital costs (in United States dollars) to identify cost drivers. A mediation model was used to investigate the relationship between these variables and hospital costs.

RESULTS

A total of 110 patients underwent primary esophageal resection. The median admission cost was $47822.7 (interquartile range: 35670.2-68214.0). The total effects on costs were $13593.9 (95%CI: 10187.1-17000.8, P < 0.001) for each increase in CD severity grade, $4781 (95%CI: 3772.7-5789.3, P < 0.001) for each increase in the number of complications, and $42552.2 (95%CI: 8309-76795.4, P = 0.015) if a key esophagectomy complication developed. Key esophagectomy complications drove the costs directly by $11415.7 (95%CI: 992.5-21838.9, P = 0.032).

CONCLUSION

The severity and number of complications, and the development of key esophagectomy complications significantly contributed to total hospital costs. Continuous institutional initiatives and strategies are needed to enhance patient outcomes and minimize costs.

Keywords: Anesthesia; Esophagectomy; Complications; Cancer; Surgery

Core Tip: Our findings show that complications following esophagectomy are common, with most patients experiencing at least one complication, and over 40% of patients developing a major complication. Moreover, we have demonstrated that the severity, number of complications and the presence of esophagectomy key complications significantly contributed to total hospital costs. Reoperation, prolonged intensive care stay and hospital stay were major drivers of hospital costs. This study highlights the importance of a continuous institutional quality review to prevent and mitigate complications, and the need for improved intervention strategies to enhance patient outcomes and minimize costs.