By Onco’Zine StaffWriter

Surgical complications can substantially increase costs in cancer care, but improvements in patient safety, by reducing common errors, may be able to improve the quality of healthcare.

According to a new study published online December 30, 2013, in Cancer, The Journal of the American Cancer Society, researchers from Rice University’s Baker Institute for Public Policy and the University of Texas MD Anderson Cancer Center in Houston report that consistently higher costs are associated with cancer surgery complications, and they suggest that by addressing this issue, it could result in substantial healthcare savings.[1]

The authors note that the costs of cancer care in the United States were estimated to reach $124.6 billion in 2010 and could reach $207 billion in 2020?a 66% increase. The influence of complications on medical outcomes and costs of care has not received a great deal of attention, and in cancer treatment, there tends to be a higher threshold of tolerance for complications as compared to other conditions.[2]

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…because we know so little about the links between provider volume, care processes, complications, and costs, this analysis represents an important first step in examining these relations…

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Additionally, it is more difficult to determine direct causality in cancer because of the complex interactions between patient, tumor, multimodality therapy, along with provider factors that all may contribute to less than optimal outcomes. In general, complications that follow high risk surgeries have been independently associated with increased resource use, and if these links can be confirmed in cancer care, efforts to reduce potentially avoidable complications will not only lower patient morbidity but have the opportunity to curb growing health care costs.

Patient safety-related complications
In their study, the authors used the Agency for Healthcare Research and Quality‘s (AHRQ) Patient Safety Indicators’ (PSIs) definitions to identify patient safety-related complications in Medicare claims data. PSIs are a set of transparent outcome measures that provide information on potential in-hospital complications and adverse events after surgeries, procedures and childbirth.

The team conducted an analysis of Medicare claims data from 2005 to 2009 for all 50 states to look at the relation between costs and patient complications for 6 cancer resections: colectomy (n = 150,733), pulmonary lobectomy (n = 52,202), rectal resection (n = 25,892), pancreatic resection (n = 12,135), esophagectomy (n = 3857), and pneumonectomy (n = 2981). There was substantial variation in the frequency of procedures, average mortality rate, and average cost per patient for the different resections.

Overall PSI rates ranged from a low of 0.01% for postoperative hip fracture to a high of 2.58% for respiratory failure. Death among inpatients with serious treatable complications, postoperative respiratory failure, postoperative thromboembolism, and accidental puncture/laceration were >1% for all 6 cancer operations.
Several PSIs?including decubitus ulcer, death among surgical inpatients with serious treatable complications, and postoperative thromboembolism?raised hospitalization costs by ?20% for most cancer surgery types. Postoperative respiratory failure resulted in a cost increase >50% for all cancer resections.

Increasing hospitalization costs
The most frequent PSIs were death in surgical inpatients with serious treatable complications, postoperative respiratory failure, postoperative pulmonary embolism or deep vein thrombosis, and accidental puncture/laceration. Other complications were related to anesthesia, a foreign object being left inside a patient during a procedure, postoperative hip fractures, and postoperative physiologic and metabolic derangement.

Several of the PSIs increased hospitalization costs by more than 20% for most types of cancer surgery. After adjusting for confounders including patient, hospital, and tumor factors, costs still rose by 53% to 77% for respiratory failure, 20% to 54% for death in surgical inpatients with serious treatable conditions, 28% to 37% for postoperative pulmonary embolism or deep vein thrombosis, and 28% to 60% for decubitus ulcer for all procedures (P < .001).

Surgical complications is an area that needs more study, the authors note. ?We may not identify all complication measures that are important determinants of surgeon and hospital costs,? they conclude. ?However, because we know so little about the links between provider volume, care processes, complications, and costs, this analysis represents an important first step in examining these relations.?

For more information:
[1] Short MN, Aloia TA, Ho V. The influence of complications on the costs of complex cancer surgery. Cancer. 2013 Dec 30. doi: 10.1002/cncr.28527. [Full Article][PubMed]
[2] Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117-228.[Article][PubMed]

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