Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy

• Published in: European journal of cardio-thoracic surgery Vol. 27; no. 2; pp. 329 - 333
• Main Authors: Varela, Gonzalo, Jiménez, Marcelo F., Novoa, Nuria, Aranda, José L.
• Format: Journal Article
• Language: English
• Published: Germany Elsevier Science B.V 01.02.2005
• Subjects: Adverse outcomes; Empyema, Pleural - etiology; Female; Hospital Costs; Humans; Length of Stay - economics; Lung - surgery; Lung Neoplasms - complications; Lung Neoplasms - economics; Lung Neoplasms - surgery; Lung resection; Male; Pneumonectomy - economics; Pneumonia - etiology; Postoperative air-leak; Postoperative Complications - economics; Proportional Hazards Models; Retrospective Studies; Adverse outcomes; Hospital costs; Postoperative air-leak; Lung resection
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2004.11.005

Objective: Prolonged air leak (PAL) after pulmonary surgery is afrequent occurrence and is reported to cause increased length of stay (LOS)and hospital costs although the costs directly attributable to PAL havenever been published. The present study aims to compare the prevalence ofpulmonary complications (atelectasis, pneumonia and pleural empyema) inpatients with or without PAL and to quantify economic costs directlyincurred by PAL in a series of pulmonary lobectomies. Methods: Aseries of 238 patients scheduled for pulmonary lobectomy (January2001–December 2003) have been reviewed. PAL was defined as airleakage which prevented hospital discharge for 5 postoperative days orover. Hospital costs (excluding operating room) for pulmonary lobectomieshave been obtained and calculated as mean daily costs. Age, body massindex, diagnosis, Charlson co-morbidity index, ppoFEV1 and majorpost-operative cardio-pulmonary morbidity have been used to construct aCox-regression model for hospital stay, considering deaths as censoredcases. Individual risk function has been used as a new variable andexpected LOS calculated for each case. This data has been used to estimatetotal excess hospital stay and costs incurred by cases with PAL.Results: Prevalence of PAL was 23 cases (9, 7%). Mean daily hospitalcost for lobectomy was 632.49€. For the whole series, mean hospitalstay was 5 days (10 days for patients with PAL). PAL cases had morepostoperative pulmonary morbidity (risk-ratio: 2.78). Variables showingindependent influence on stay were: diagnosis of non-malignant disease(P=0.001); FEV1ppo (P=0.032) andcardio-respiratory morbidity (P≪0.001). Calculated total excessstay for PAL patients was 62 days. A total expense of 39,437.39€(38,724.96€ hospital and 712.43€ pharmacy charges) were estimatedto result from postoperative air-leak. Conclusions: PAL patients areprone to developing major postoperative morbidity. PAL calculated costs areover 13000€ per year. This data is useful for designing technical cost-effective strategies to avoid post-lobectomy PAL.