Cancer surgery complication costs burden US healthcare

The cost of complications from cancer surgery places a tremendous financial strain on the healthcare system, according to a new study.

The study, published in the December 30, 2013, online edition of Cancer, was co-authored by Marah Short, a senior research analyst with Rice University's Baker Institute for Public Policy; Vivian Ho, the chair in health economics at the Baker Institute, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine; and Thomas Aloia, an associate professor in the MD Anderson Cancer Center's Department of Surgical Oncology.

"It is widely known that outcomes after cancer surgery vary widely, depending on interactions between patient, tumor, neoadjuvant therapy, and provider factors," Short said in a statement from Rice University. "An area of cancer care that has received little attention is the influence of complications on medical outcomes and costs of care.”

Using the Agency for Healthcare Research and Quality's Patient Safety Indicators' (PSIs) definitions to identify patient safety-related complications in Medicare claims data, the researchers analyzed hospital and inpatient physician claims from all 50 US states for the years 2005 through 2009. They examined 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection.

They found that several PSIs-including decubitus ulcer, postoperative thromboembolism, and death among surgical inpatients with serious treatable complications-raised hospitalization costs by more than 20% for most types of cancer surgery. Postoperative respiratory failure resulted in a cost increase of more than 50% for all cancer resections.

Overall PSI rates for complications arising from the 6 procedures ranged from a low of 0.01% for postoperative hip fracture to a high of 2.58% for respiratory failure. Rates of postoperative respiratory failure, death among inpatients with serious treatable complications, postoperative thromboembolism and accidental puncture/laceration were more than 1% for all 6 cancer operations.

"These data indicate that even in the complex cancer care environment, in which many controllable and uncontrollable variables may contribute to complications, improvements in patient safety indicators are highly likely to reduce costs," Short said.

The authors' findings come against the backdrop of rising cancer care costs in the United States, which were estimated at $124.6 billion in 2010 and could rise by 66% to $207 billion by 2020.

"We may not have identified all of the complication measures that are important determinants of surgeon and hospital costs. However, because we know so little about the links between provider volume, care processes, complications and costs, this analysis represents an important first step in examining these relations,” Short said.