Elective colectomy financial and opportunity cost analysis: diagnosis, case type, diversion, and complications

• Published in: European surgery Vol. 54; no. 2; pp. 104 - 112
• Main Authors: Antonacci, Anthony C., Antonacci, Christopher L., Carsky, Katherine, Dechario, Samuel P., Husk, Gregg, Caulfield, Dana, Allinger, David, Coppa, Gene, Jarrett, Mark
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-04-2022
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Surgery; Vascular Surgery; Non-inflammtory diseases; Below peritoneal reflection; Inflammatory diseases; Above peritoneal reflection
• ISSN: 1682-8631; 1682-4016
• DOI: 10.1007/s10353-021-00716-w

Summary
Background
The purpose of this study was to financially profile four different types of elective colectomy resection in relation to diagnosis and complications.
Methods
A total of 1420 colectomies from three centers within our system were analyzed for diagnostic, complications, financial, length of stay (LOS), and case mix index (CMI) data for four procedure categories: colectomy above peritoneal reflection (AR) with diversion, colectomy AR without diversion, colectomy below peritoneal reflection (BR) with diversion, and colectomy BR without diversion. The incidence of complications and costs were compared between procedure groups. Logit models were used for probabilities of complications and Poisson for rate analysis.
Results
Elective colectomies AR were performed 72% of the time for non-inflammatory diagnoses (benign tumors, polyps, rectal prolapse, malignant tumors), whereas resections BR were performed 64% of the time for inflammatory diagnoses (diverticulitis, Crohn’s, ulcerative colitis, perforation, obstruction, sepsis, fistulae). Thus, diversion was performed in a higher proportion of cases with inflammatory diagnoses and cases requiring diversion had higher complication rates in both AR (16% vs. 5%) and BR (19% vs. 6%) resections.
Conclusion
Inflammatory diagnoses appear to drive the indication for diversion following elective colectomy. Colectomies with diversion have complication rates 1.36 times higher than without diversion, as well as excess LOS and costs. Resections AR with diversion had more than twice the proportion of complications as without diversion. Preoperative mitigation of inflammatory risk factors may decrease the rate of diversion and reduce complications, financial risk, and opportunity cost.