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Erschienen in: European Surgery 2/2022

27.05.2021 | original article

Elective colectomy financial and opportunity cost analysis: diagnosis, case type, diversion, and complications

verfasst von: MD, SM Anthony C. Antonacci, BA Christopher L. Antonacci, MD Katherine Carsky, Samuel P. Dechario, MD Gregg Husk, BS, MBA Dana Caulfield, BA, MBA David Allinger, MD Gene Coppa, MD, MBA, MS Mark Jarrett

Erschienen in: European Surgery | Ausgabe 2/2022

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Summary

Background

The purpose of this study was to financially profile four different types of elective colectomy resection in relation to diagnosis and complications.

Methods

A total of 1420 colectomies from three centers within our system were analyzed for diagnostic, complications, financial, length of stay (LOS), and case mix index (CMI) data for four procedure categories: colectomy above peritoneal reflection (AR) with diversion, colectomy AR without diversion, colectomy below peritoneal reflection (BR) with diversion, and colectomy BR without diversion. The incidence of complications and costs were compared between procedure groups. Logit models were used for probabilities of complications and Poisson for rate analysis.

Results

Elective colectomies AR were performed 72% of the time for non-inflammatory diagnoses (benign tumors, polyps, rectal prolapse, malignant tumors), whereas resections BR were performed 64% of the time for inflammatory diagnoses (diverticulitis, Crohn’s, ulcerative colitis, perforation, obstruction, sepsis, fistulae). Thus, diversion was performed in a higher proportion of cases with inflammatory diagnoses and cases requiring diversion had higher complication rates in both AR (16% vs. 5%) and BR (19% vs. 6%) resections.

Conclusion

Inflammatory diagnoses appear to drive the indication for diversion following elective colectomy. Colectomies with diversion have complication rates 1.36 times higher than without diversion, as well as excess LOS and costs. Resections AR with diversion had more than twice the proportion of complications as without diversion. Preoperative mitigation of inflammatory risk factors may decrease the rate of diversion and reduce complications, financial risk, and opportunity cost.
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Metadaten
Titel
Elective colectomy financial and opportunity cost analysis: diagnosis, case type, diversion, and complications
verfasst von
MD, SM Anthony C. Antonacci
BA Christopher L. Antonacci
MD Katherine Carsky
Samuel P. Dechario
MD Gregg Husk
BS, MBA Dana Caulfield
BA, MBA David Allinger
MD Gene Coppa
MD, MBA, MS Mark Jarrett
Publikationsdatum
27.05.2021
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 2/2022
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-021-00716-w