Cost Drivers of Elective Colon and Rectal Surgery: A Retrospective Cohort Analysis

BACKGROUND: Colorectal surgery is expensive. Few studies have evaluated complications as an economic cost driver, and there is little evidence comparing multiple cost drivers of colorectal surgery to determine the most effective means of reducing total cost.OBJECTIVE: This study aimed to determine the effects of surgical techniques, use of enhanced recovery protocols, and presence or absence of complications on the total cost of hospitalization for elective colorectal surgery.DESIGN: A retrospective cohort analysis using data from 2011 to 2018 was performed. The primary end point was a mean cost per hospitalization. The cost was compared between patients who experienced minimally invasive versus open surgeries, enhanced recovery after surgery protocols versus not, and complications versus none.SETTINGS: This study was conducted at a university-affiliated teaching hospital in the Northeastern United States.PATIENTS: Adult patients who have undergone elective colorectal surgery were included.MAIN OUTCOME MEASURES:The primary outcome for this study was the mean cost per hospitalization calculated using inpatient cost based on the total cost of the episode of care.RESULTS: A total of 1039 patients met the criteria for inclusion. The average cost of all hospitalizations was $19,801. Multivariate analysis demonstrated that enhanced recovery protocols substantially lowered the cost of care by $6392 (p = 0.001), whereas complications increased the cost of care by $16,780 per episode (p < 0.001). When complications occurred, enhanced recovery protocols reduced the cost by $17,963 (p = 0.010).LIMITATIONS: This retrospective cohort study performed at a single institution has inherent limitations, including confounding and selection bias.CONCLUSIONS: For elective colorectal surgery, complications are associated with significantly increased costs. Avoiding complications should be a priority to reduce costs. Enhanced recovery protocols are associated with significantly reduced costs. Surgeons should focus future research efforts on improving protocols and processes that decrease postoperative complications to improve patient outcomes and to reduce costs associated with elective colorectal hospitalizations. See Video Abstract at .

Automated summary

This study aimed to determine the effects of surgical techniques, use of enhanced recovery protocols, and presence or absence of complications on the total cost of hospitalization for elective colorectal surgery. The results showed that enhanced recovery protocols significantly reduced the cost, while complications significantly increased the cost.