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Timing and Cost of Wound Complications After Colorectal Resection. Diseases of the colon and rectum Graham, L. A., Wagner, T. H., Sambare, T. D., Hawn, M. T. 2021; 64 (12): 1551-1558

Abstract

BACKGROUND: More than 50% of postoperative wound complications occur after discharge. They are the most common postoperative complication and the most common reason for readmission after a surgical procedure. Little is known about the long-term costs of postdischarge wound complications after surgery.OBJECTIVE: We sought to understand the differences in costs and characteristics of wound complications identified after hospital discharge for patients undergoing colorectal surgery in comparison with in-hospital complications.DESIGN: This is an observational cohort study using Veterans Health Administration Surgical Quality Improvement Program data.SETTING: This study was conducted at a Veterans Affairs medical center.SETTING: Patients undergoing colorectal resection between October 1, 2007 and September 30, 2014.MAIN OUTCOME MEASURES: The primary outcomes measured were adjusted costs of care at discharge, 30 days, and 90 days after surgery.RESULTS: Of 20,146 procedures, 11.9% had a wound complication within 30 days of surgery (49.2% index-hospital, 50.8% postdischarge). In comparison with patients with index-hospital complications, patients with postdischarge complications had fewer superficial infections (65.0% vs 72.2%, p < 0.01), more organ/space surgical site infections (14.3% vs 10.1%, p < 0.01), and higher rates of diabetes (29.1% vs 25.0%, p = 0.02), and they were to have had a laparoscopic approach for their surgery (24.7% vs 18.2%, p < 0.01). The average cost including surgery at 30 days was $37,315 (SD = $29,319). Compared with index-hospital wound complications, postdischarge wound complications were $9500 (22%, p < 0.001) less expensive at 30 days and $9736 (15%, p < 0.001) less expensive at 90 days. Patients with an index-hospital wound complication were 40% less likely to require readmission at 30 days, but their readmissions were $12,518 more expensive than readmissions among patients with a newly identified postdischarge wound complication (p < 0.001).LIMITATIONS: This study was limited to patient characteristics and costs accrued only within the Veterans Affairs system.CONCLUSIONS: Patients with postdischarge wound complications have lower 30- and 90-day postoperative costs than those with wound complications identified during their index hospitalization and almost half were managed as an outpatient.TIEMPO Y COSTO DE LAS COMPLICACIONES LA HERIDA DESPUS DE LA RESECCIN COLORRECTAL: ANTECEDENTES:Mas del 50% de complicaciones postoperatorias de la herida ocurren despues del alta. Es la complicacion postoperatoria mas comun y el motivo mas frecuente de reingreso despues del procedimiento quirurgico. Poco se sabe sobre los costos a largo plazo de las complicaciones de la herida despues del alta quirurgica.OBJETIVO:Intentar en comprender las diferencias en los costos y las caracteristicas de las complicaciones de la herida, identificadas despues del alta hospitalaria, en pacientes sometidos a cirugia colorrectal, en comparacion con las complicaciones intrahospitalarias.DISENO:Estudio de cohorte observacional utilizando datos del Programa de Mejora de la Calidad Quirurgica de la Administracion de Salud de Veteranos.ENTORNO CLINICO:Administracion de Veteranos.PACIENTES:Pacientes sometidos a reseccion colorrectal entre el 1/10/2007 y el 30/9/2014.PRINCIPALES MEDIDAS DE VALORACION:Costos de atencion ajustados al alta, 30 dias y 90 dias despues de la cirugia.RESULTADOS:De 20146 procedimientos, el 11,9% tuvo una complicacion de la herida dentro de los 30 dias de la cirugia. (49,2% indice hospitalario, 50,8% despues del alta). En comparacion con los pacientes, del indice de complicaciones hospitalarias, los pacientes con complicaciones posteriores al alta, tuvieron menos infecciones superficiales (65,0% frente a 72,2%, p <0,01), mas infecciones de organos/espacios quirurgicos (14,3% frente a 10,1%, p <0,01), tasas mas altas de diabetes (29,1% versus 25,0%, p = 0,02), y deberian de haber tenido un abordaje laparoscopico para su cirugia (24,7% versus 18,2%, p <0,01). El costo promedio, incluida la cirugia a los 30 dias, fue de $ 37,315 (desviacion estandar = $ 29,319). En comparacion con el indice de complicaciones de las herida hospitalaria, las complicaciones de la herida despues del alta fueron $ 9,500 (22%, p <0,001) menor costo a los 30 dias y $ 9,736 (15%, p<0,001) y menor costo a los 90 dias. Los pacientes con indice de complicacion de la herida hospitalaria, tenian un 40% menos de probabilidades de requerir reingreso a los 30 dias, pero sus reingresos eran $ 12,518 mas costosos que los reingresos entre los pacientes presentando complicacion de la herida recien identificada despues del alta (p <0,001).LIMITACIONES:Limitado a las caracteristicas del paciente y los costos acumulados solo dentro del sistema VA.CONCLUSIONES:Pacientes con complicaciones de la herida post alta, tienen menores costos postoperatorios a los 30 y 90 dias, que aquellos con complicaciones de la herida identificadas durante su indice de hospitalizacion y aproximadamente la mitad fueron tratados de forma ambulatoria.

View details for DOI 10.1097/DCR.0000000000002065

View details for PubMedID 34747918