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The Economic Burden of Complications Occurring in Major Surgical Procedures: a Systematic Review

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Abstract

Objectives

On the basis of a systematic review, we aimed to establish the cost and drivers of cost and/or resource use of intra- and perioperative complications occurring as a result of selected major surgical procedures, as well as to understand the relationship between costs and severity of complication and, consequently, the economic burden they represent. We also assessed the clinical and economic methodologies used to derive costs and resource use across the studies with a view to providing guidance on reporting standards for these studies.

Methods

We searched EMBASE, MEDLINE and Econlit (from 2002 to 2012) for study publications including resource use/cost data relating to surgical complications.

Results

We identified 38 relevant studies on pancreatic (n = 14), urologic (n = 4), gynaecological (n = 6), thoracic (n = 13) and hepatic surgery (n = 1). All studies showed that complications lead to higher resource use and hospital costs compared with surgical procedures without complications. Costs depend on type of complication and complication severity, and are driven primarily by prolonged hospitalisation. There was considerable heterogeneity between studies with regard to patient populations, outcomes and procedures, as well as a lack of consistency and transparency of reporting of costs/resource use. Complication severity grading systems were used infrequently.

Conclusions

The overall conclusions of included studies are consistent: complications represent an important economic burden for health care providers. We conclude that more accurate and consistent data collection is required to serve as input for good-quality economic analyses, which in turn can inform hospital decisions on cost-efficient allocation of their limited resources.

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Acknowledgments

This study was funded by Takeda Pharmaceuticals International GmbH, Zurich, Switzerland. Annika Bergman is an employee of Takeda. Ajay S. Patel and Brigitte W. Moore received honoraria from Takeda for conducting this systematic review and writing the article. Ulf Haglund has, on occasion, been contracted as a lecturer by Nycomed/Takeda, last in 2011. The authors thank Felicity Allen (FA) and Sarah Collins (SC), employees of Abacus International, who both received honoraria from Takeda, for their help with the selection of publications to be included.

Author contributions

Ajay Patel and Annika Bergman designed the systematic review and contributed to the presentation and analysis of results, as well as the discussion. Ajay Patel conducted screening of abstracts and full publications. Brigitte Moore and Ulf Haglund performed the analysis and presentation of results, as well as their interpretation for the discussion. Annika Bergman is the guarantor for the overall content.

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Authors and Affiliations

  1. Abacus International, Bicester, UK

    Ajay S. Patel & Brigitte W. Moore

  2. Takeda Pharmaceuticals International GmbH, Glattpark-Opfikon, Switzerland

    Annika Bergman

  3. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    Ulf Haglund

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  1. Ajay S. Patel
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Correspondence to Ajay S. Patel.

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Patel, A.S., Bergman, A., Moore, B.W. et al. The Economic Burden of Complications Occurring in Major Surgical Procedures: a Systematic Review. Appl Health Econ Health Policy 11, 577–592 (2013). https://doi.org/10.1007/s40258-013-0060-y

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