Incremental cost of complications in colectomy: a warranty guided approach to surgical quality improvement

Abstract Background We assessed the warranty cost for colectomy at a single institution, as defined by the additional cost of treating complications distributed across all patients treated. Methods All segmental colectomies from July 8 to June 12 were reviewed for 0, 1, 2, and ≥3 complications. Warr...

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Published inThe American journal of surgery Vol. 207; no. 3; pp. 422 - 426
Main Authors Asgeirsson, Theodor, M.D, Jrebi, Nezar, M.D, Feo, Leandro, M.D, Kerwel, Therese, M.D, Luchtefeld, Martin, M.D, Senagore, Anthony J., M.D
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.03.2014
Elsevier Limited
Subjects
Aged
Colectomy
Colectomy - adverse effects
Colectomy - economics
Colectomy - standards
Complication
Cost
Cost control
Female
Humans
Infections
Laparoscopy
Male
Middle Aged
Patients
Postoperative Complications - economics
Quality Improvement - economics
Standard deviation
Surgery
Surgical Quality
Variance analysis
Warranties
Warranty
Complication
Colectomy
Warranty
Cost
Surgical Quality
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Summary:Abstract Background We assessed the warranty cost for colectomy at a single institution, as defined by the additional cost of treating complications distributed across all patients treated. Methods All segmental colectomies from July 8 to June 12 were reviewed for 0, 1, 2, and ≥3 complications. Warranty cost is defined as follows: ([mean additional cost of the case with complication(s) – mean base case cost] × number of episodes)/total population. Results Thousand four hundred twenty-two colectomies were analyzed. The lowest cost case was a laparoscopic resection with 0 complications ($7,739 ± 4,150). Warranty costs were less for laparoscopic versus open colectomy (0 - $0, 1 - $128, 2 - $66, ≥3 - $248 vs 0 - $1,036, 1 - $501, 2 - $520, ≥3 - $1,971). This was true for costs associated with readmission ($303 vs $1,519). Emergency status and elderly status also impacted warranty costs. Conclusions The data demonstrate that warranty costs were highest with open colectomy, emergency cases, and the elderly. These data can be used to measure both quality and cost impact of mitigation strategies.
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ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2013.11.002