Impact of processes of care aimed at complication reduction on the cost of complex cancer surgery

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dc.citation.firstpage610en_US
dc.citation.lastpage615en_US
dc.contributor.authorShort, Marah Noelen_US
dc.contributor.authorHo, Vivianen_US
dc.contributor.authorAloia, Thomas A.en_US
dc.contributor.funderNational Cancer Institute, National Institutes of Healthen_US
dc.contributor.funderCancer Prevention and Research Institute of Texasen_US
dc.contributor.orgJames A. Baker III Institute for Public Policyen_US
dc.date.accessioned2016-01-15T17:21:43Zen_US
dc.date.available2016-01-15T17:21:43Zen_US
dc.date.issued2015en_US
dc.description.abstractBackground and Objectives: Health care providers add multiple processes to the care of complex cancer patients, believing they prevent and/or ameliorate complications. However, the relationship between these processes, complication remediation, and expenditures is unknown. Methods: Data for patients with cancer diagnoses undergoing colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection were obtained from hospital and inpatient physician Medicare claims for the years 2005 to 2009. Risk-adjusted regression analyses measured the association between hospitalization costs and processes presumed to prevent and/or remedy complications common to high-risk procedures. Results: After controlling for comorbidities, analysis identified associations between increased costs and the use of multiple processes, including arterial lines (4-12% higher; p<0.001), central venous catheters (11-22% higher; p<0.001) and pulmonary artery catheters (23-33% higher; p<0.001). Epidural analgesia was not associated with higher costs. Consultations were associated with 24-44% (p<0.001) higher costs, and total parenteral nutrition was associated with 13-31% higher costs for multiple procedures (p<0.001) Conclusions: Many frequently utilized processes and services presumed to avoid and/or ameliorate complications are associated with increased surgical oncology costs. This suggests that the patient-centered value of each process should be measured on a procedure-specific basis. Likewise, further attention should be focused on defining the efficacy of each of these costly, but frequently unproven, additions to perioperative care.en_US
dc.identifier.citationShort, Marah Noel, Ho, Vivian and Aloia, Thomas A.. "Impact of processes of care aimed at complication reduction on the cost of complex cancer surgery." <i>Journal of Surgical Oncology,</i> 112, no. 6 (2015) Wiley: 610-615. http://dx.doi.org/10.1002/jso.24053.en_US
dc.identifier.grantIDR01CA138640 (National Cancer Institute, National Institutes of Health)en_US
dc.identifier.grantIDRP101207 (Cancer Prevention and Research Institute of Texas)en_US
dc.identifier.urihttps://hdl.handle.net/1911/87839en_US
dc.subjectcanceren_US
dc.subjectcost analysisen_US
dc.subjectsurgeryen_US
dc.subjectprocess of careen_US
dc.titleImpact of processes of care aimed at complication reduction on the cost of complex cancer surgeryen_US
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