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Characterizing the costs of complications after cystectomy
Matthew Mossanen, MA, Ross Krasnow, MD, Matthew Ingham, MD, Mark Preston, MD, MPH, Albert Ha, MD, Stuart Lipsitz, ScD, Adam S. Kibel, MD, Steven L. Chang, MD MS.
Harvard University - Brigham and Women's Hospital, Boston, MA, USA.

Introduction: Radical cystectomy (RC) is subject to substantial morbidity and mortality. Understanding costs of different categories of complications may be valuable in guiding efforts to improve care. We studied the cost of different categories of complications in RC to identify drivers of expenditures.
Methods: Using the Premier Hospital Database we identified patients who underwent RC for BC(BC). Ninety-day complications were captured using ICD9 codes. Complications were categorized according to Agency for Healthcare Research and Quality Clinical Classification Software. The primary outcome was cost of complication and secondary outcomes were mortality, length of stay (LOS), and discharge disposition. A generalized liner model conforming to a gamma distribution was used to evaluate cost data and all models were adjusted for patient, hospital, and surgery characteristics.
Results: We identified 9,137 RC patients, representing a weighted population of 57,553 patients from 600 hospitals across the US between 2003-2013. Venous thromboembolism (VTE) was the costliest index complication costing over $10,000 and pulmonary complications were the most expensive readmission complication costing over $30,000. After room and board, pharmacy and laboratory costs were the primary sources behind VTE costs. The three most costly index complications were VTE, infectious, and wound and soft tissue and pulmonary (p<0.001, compared to no complication). A complication increased the length of stay by 4 days. Nearly 1 in 3 RC patients were readmitted within 90 days and the top three costliest readmission complications were pulmonary, VTE, and neurological. Being married, fewer comorbidities, shorter operations, lack of transfusions, teaching hospitals, high volume hospitals, and high volume surgeons were associated with statistically significantly lower costs of complications after RC.
Conclusions: Complications after RC can be cost stratified. VTE is one of the most expensive complications after RC during index stay and readmission. This work highlights potential candidates for future quality improvement initiatives in BC care. <!--EndFragment-->


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