No information exists concerning the economic costs of differing outcomes after anatomic pulmonary resection. We evaluated our experience in a high volume thoracic surgery program to determine costs of no complications versus complications or death.
Retrospective analysis of a prospectively maintained thoracic surgery database from January 2005–September 2007 identified 3 outcome cohorts of anatomic pulmonary resection: uncomplicated (U), survivors with one or more major complications (C) or operative death before discharge or within 30 days (D). Anatomic resections included lobectomy (lobectomy, sleeve lobectomy, bilobectomy, segmentectomy) and pneumonectomy (standard, carinal, completion, extrapleural, intrapericardial) categories. Wedge resections were excluded. Complication categories were strictly defined (pulmonary, wound, etc). Clinical information was linked to an administrative database to evaluate hospital costs (exclusive of professional fees). Univariate analysis evaluated patient outcomes, hospital costs and postop length of stay (LOS-days), combining C & D due to infrequency of these occurrences. Logarithmic transformations were performed on costs and LOS for analysis. We evaluated the incremental cost for each major complication category > 1.
294 anatomic resections consisted of 268 lobectomies (lobectomy 229, sleeve 8, bilobectomy 20, segmentectomy 11) & 26 pneumonectomies (standard 13, carinal 1, completion 3, extrapleural 4, intrapericardial 5). Analysis revealed: Median LOS was shorter for Lobectomy: U(5 days) vs C+D(8.5+21.5 days) & Pneumonectomy: U(6 days) vs C+D(14+0 days) *(p = 0.00), but was not different between pneumonectomy & lobectomy (p = 0.16). Cost($ x 1000, mean ± SD): Pneumonectomy was costlier than lobectomy †(p = 0.003). Lobectomy C+D($33.5 ± 30.5 + $77.2 ± 29.4)was costlier than U($18.4 ± 6.2); Pneumonectomy C+D($61.4 ± 37.4 + $16.2) was costlier than U($21.7 ± 5.7) β(p < 0.001). Costs increased quadratically with the number of major complications.
Operative death or postoperative complications after anatomic pulmonary resection are costly economic outcomes.
Aside from the human toll of complications or death on patients and their families, patients & payers should seek thoracic surgery providers with low complication rates and operative mortality.
John Handy, No Financial Disclosure Information; No Product/Research Disclosure Information