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2024 ; 16
(7
): 2255-2269
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Cost burden following esophagectomy: A single centre observational study
#MMPMID39087114
Buchholz V
; Lee DK
; Liu DS
; Aly A
; Barnett SA
; Hazard R
; Le P
; Kioussis B
; Muralidharan V
; Weinberg L
World J Gastrointest Surg
2024[Jul]; 16
(7
): 2255-2269
PMID39087114
show ga
BACKGROUND: Cost analyses of patients undergoing esophagectomy is valuable for
identifying modifiable expenditure drivers to target and curtail costs while
improving the quality of care. We aimed to define the cost-complication
relationship after esophagectomy and delineate the incremental contributions to
costs. AIM: To assess the relationship between the hospital costs and potential
cost drivers post esophagectomy and investigate the relationship between the
cost-driving variables (predicting variables) and hospital costs (dependent
variable). METHODS: In this retrospective single center study, the severity of
complications was graded using the Clavien-Dindo (CD) classification system. Key
esophagectomy complications were categorized and defined according to consensus
guidelines. Raw costing data included the in-hospital costs of the index
admission and any unplanned admission within 30 postoperative days. We used
correlation analysis to assess the relationship between key clinical variables
and hospital costs (in United States dollars) to identify cost drivers. A
mediation model was used to investigate the relationship between these variables
and hospital costs. RESULTS: A total of 110 patients underwent primary esophageal
resection. The median admission cost was $47822.7 (interquartile range:
35670.2-68214.0). The total effects on costs were $13593.9 (95%CI:
10187.1-17000.8, P < 0.001) for each increase in CD severity grade, $4781 (95%CI:
3772.7-5789.3, P < 0.001) for each increase in the number of complications, and
$42552.2 (95%CI: 8309-76795.4, P = 0.015) if a key esophagectomy complication
developed. Key esophagectomy complications drove the costs directly by $11415.7
(95%CI: 992.5-21838.9, P = 0.032). CONCLUSION: The severity and number of
complications, and the development of key esophagectomy complications
significantly contributed to total hospital costs. Continuous institutional
initiatives and strategies are needed to enhance patient outcomes and minimize
costs.