Association of Hospital Costs With Complications Following Total Gastrectomy for Gastric Adenocarcinoma

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Abstract
National discussions on the value of health care have resulted in increased interest in understanding the cost and quality of care. In surgery, this has resulted in an intense focus on studying postoperative complications and their cost in a variety of different surgical conditions. Whether from single institutions,1-4 hospital networks,5,6 or national databases,7-9 it has been consistently shown that surgical complications increase postoperative cost, often by multiples of the cost of an uncomplicated operation. However, these studies have failed to fully describe the components of hospital care that drive these higher costs. Increased length of stay following complications is a consistent driver, but the studies are hampered by inconsistent methods and reporting. Costs are also captured in disparate ways, including hospital reimbursement by payers,7-9 hospital charges to payers,2,5 or not otherwise specified costs.1,3,4,6 In most cases, it is unclear how these costs can be compared either between institutions or in relation to the cost to society. We are not aware of any studies with detailed descriptions of the source of increased costs following surgical complications.

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