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Costs of Potential Complications of Care for Major Surgery Patients

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

Jennifer Daley

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory, Health Services Research and Development, Department of Medicine, Brockton/West Roxbury, Veterans Affairs Medical Center, West Roxbury, Massachusetts

Charles C. Duncan

Boston University School of Public Health

Roger B. Davis

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

Gerald A. Coffman

Departments of Neurosurgery and Pediatrics, Yale University School of Medicine

Lisa I. Iezzoni

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

We examined computerized hospital discharge ab stract data from 372,680 major surgery patients admit ted to 404 California acute care hospitals in 1988 to identify potential complications of care. At least one potential in-hospital complication occurred for 10.8% of patients. Patients with complications were older and more likely to die in-hospital (9.4% compared to 1.0%, P < 0.0001). On average, patients with complications had longer stays (13.5 versus 5.4 days, p < 0.0001) and higher total charges ($30,896 versus $9,239,p < 0.0001). After adjusting for demographic, clinical, and hospital factors, patients with potential complications averaged $16,023 higher total hospital charges than uncompli cated patients. Complications were associated with 96.6% (95% confidence interval = 95.2%, 98.0%) higher hospital charges after adjusting for these factors. Across all patients, complications were related to over $647 million in additional total hospital charges for these major surgery patients.

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