J. P. Fischer 36.01 ASC20150683 1 Plastic Surgery ...

12/17/2014 ASC 2015 Abstracts from Oral: Cost Effectiveness

http://www.ascabstracts.org/printabslist2.php?session=36 1/17

36.01 ASC20150683

Costutility of prophylactic mesh relative to primary suture repair for highrisk laparotomiesJ. P. Fischer1, M. N. Basta1, N. Krishnan2, J. D. Wink1, S. J. Kovach1 1University Of Pennsylvania,Division OfPlastic Surgery,Philadelphia, PA, USA 2Georgetown University Medical Center,Plastic Surgery,Washington,DC, USAScientific Area: Cost Effectiveness Clinical Area: Crosscutting or N/A

Introduction Although hernia repair with mesh can be successful, prophylactic mesh augmentation (PMA) represents apotentially useful preventative technique to mitigate incisional hernia (IH) risk select highrisk patients. The efficacy,costbenefit, and societal value of such an intervention is not clear. The aim of this study is to determine the costutilityof using prophylactic mesh to augment midline fascial incisions. Methods A systematic review was performedidentifying articles containing comparative outcomes for PMA and suture closure of highrisk laparotomies. A webbased visual analog scale survey was administered to 300 nationallyrepresentative community members to determinequalityadjusted lifeyears (QALYs) for several health states related to hernia repair (GfK Research). A decision treemodel was employed to evaluate the costutility of using PMA relative to primary suture closure after electivelaparotomy. Inputs included cost (DRG, CPT, and retail costs for mesh), quality of life, and healthoutcome probabilityestimates. The cost effectiveness threshold was set at $50,000/yearoflife gained.The authors adopted the societalperspective for cost and utility estimates. The costs in this study included direct hospital costs and indirect costs tosociety, and utilities were obtained through a survey of 300 Englishspeaking members of the general public evaluating14 health state scenarios relating to ventral hernia. Results Primary suture closure without mesh demonstrated anexpected average cost of $17,182 (average QALY of 21.17) compared to $15,450 (expected QALY was 21.21) forPMA. Primary suture closure was associated with an ICER of $42,444/QALY compared to prophylactic mesh, such thatPMA was more effective and less costly. MonteCarlo sensitivity analysis was performed demonstrating moresimulations resulting in ICERs for primary suture closure above the willingnesstopay threshold of $50,000/QALYsupporting the finding that prophylactic mesh is superior in terms of costutility. Additionally, base rate analysis with anabsolute reduction in hernia recurrence rate of 15% for prophylactic mesh demonstrated that mesh could cost amaximum of $3,700 and still be costeffective. Conclusions Costutility analysis of suture repair compared to PMA ofabdominal fascia incisions demonstrates PMA was more effective, less costly, and overall more costeffective thanprimary suture closure. Sensitivity analysis demonstrates that PMA dominates at multiple levels of willingnesstopay,and is a potentially valuable, costeffective, low risk intervention to mitigate risk of IH.



36.02 ASC20150308

CostEffectiveness of Nonoperative Management of Acute Uncomplicated AppendicitisJ. X. Wu1, A. J. Dawes1, G. D. Sacks1 1UCLA David Geffen School Of Medicine,Department Of GeneralSurgery,Los Angeles, CALIFORNIA, USAScientific Area: Cost Effectiveness Clinical Area: General Surgery

Introduction: Appendectomy remains the gold standard of treatment for acute uncomplicated appendicitis.Nonetheless, there is growing evidence that nonoperative management is both safe and efficacious. Nonoperativemanagement avoids the initial cost and morbidity associated with an operation, but may result in longer hospital stays,increased readmissions, and higher risk of treatment failures. We hypothesized nonoperative management of acuteappendicitis is costeffective.

Methods: We constructed a decision tree to compare nonoperative management of acute uncomplicated appendicitisboth with and without interval appendectomy (IA) to laparoscopic appendectomy at the time of diagnosis (Fig 1).Outcome probabilities, health utilities, and direct costs were abstracted from a review of the literature, Healthcare Costand Utilization Project data, the Medicare Physician Fee schedule, and the American College of Surgeons NationalSurgical Quality Improvement Program Surgical Risk Calculator. Conservative estimates were used for operative costsand postoperative quality adjusted lifeyear (QALY) reductions to favor conventional operative management. Operativemanagement was used as the reference group for costeffectiveness comparisons. We performed Monte Carlosimulations using oneway and probabilistic sensitivity analyses to assess model parameters.

Results: Operative management had a mean cost of $12,386. Compared to the status quo, nonoperativemanagement without IA dominated as the most costeffective management strategy, costing $1,937 less and yielding0.04 additional QALY. Nonoperative management with IA was the least cost effective strategy, requiring an additional$2,880 per patient with no additional health benefit. Oneway sensitivity analysis revealed that operative managementwould become the dominant strategy if recurrence rate of acute appendicitis after nonoperative management exceeds42%, or if the total cost of operative management could be reduced below $5,568. Probabilistic sensitivity analysisrevealed that nonoperative management without IA was dominant in 100% of 10,000 iterations.

Conclusion: Nonoperative management without IA is potentially the most costeffective treatment for healthy adultswith acute uncomplicated appendicitis, and deserves serious consideration as a treatment option for a disease longthought to be definitively surgical. Further studies are necessary to better characterize the health states associated withthe various treatment outcomes.



36.03 ASC20150678

A Costutility Assessment of Mesh Selection in Clean and CleanContaminated Ventral Hernia Repair (VHR)J. P. Fischer1, M. Basta1, J. D. Wink1, N. Krishnan2, S. J. Kovach1 1University Of Pennsylvania,Division OfPlastic Surgery,Philadelphia, PA, USA 2Georgetown University Medical Center,Plastic Surgery,Washington,DC, USAScientific Area: Cost Effectiveness Clinical Area: General Surgery

PURPOSE Ventral hernia is a common, challenging, and costly problem in the United States. Meshreinforcement canreduce recurrence, but selection is poorly understood, particularly in higher risk wounds. The use of acellular dermalmatrixes (ADM) has provided a tool to perform singlestage ventral hernia repairs (VHR) in challenging wounds, but canbe associated with higher complications, cost, and poor longevity. The aim of this study is to perform a costutilityanalysis of ADM and synthetic mesh in clean and cleancontaminated (CC) VHR. METHOD A systematic review wasperformed identifying articles containing comparative outcomes for synthetic mesh and ADM repairs. A webbasedvisual analog scale survey was administered to 300 nationallyrepresentative community members to determine qualityadjusted lifeyears (QALYs) for several health states related to hernia repair (GfK Research). A Decision tree wascreated for the reference cases (VHR with ADM or synthetic) and up to six additional postoperative scenarios. Inputsincluded cost (DRG, CPT, and retail costs for mesh), quality of life, and healthoutcome probability estimates. The costeffectiveness threshold was set at $50,000/yearoflife gained (incremental cost utility ratio (ICUR)). RESULT Therewas a 16% increase in the risk of a complication occurring after VHR when using biologic mesh compared to syntheticmesh in CC fields. This risk increased to 30% in clean fields. In CC fields, there was an increase of $8,022.61 inexpected cost of VHR when using biologic mesh relative to synthetic mesh with a loss in clinical efficacy of 0.47QALYs. This resulted in an ICUR of $17,000/QALY. There was an expected increase of $11,694.02 with a clinical lossof 0.51 QALYs when using biologic mesh in clean fields resulting in an ICUR of $23,000/QALY. Sensitivity analysisrevealed that the recurrence rate of biologic mesh needs to be below 5% or the recurrence rate of synthetic meshneeds to be greater than 23% for biologic mesh to be cost effective in CC fields. In clean cases, the recurrence rate ofsynthetic mesh needs to be greater than 21% in order for biologic mesh to be cost effective. CONCLUSION This costeffectiveness analysis of mesh selection indicates that biologic meshes are not cost effective relative to synthetic meshin clean or CC defects. Specifically, from a societal perspective synthetic mesh is both cheaper and more clinicallyeffective than biologic mesh. Given the high prevalence of hernia and its associated cost to society, our data iscritically important in improving costeffective repair techniques, providing valuebased care, and conserving healthcareresources in an everchanging healthcare environment.



36.04 ASC20150430

National Analysis of Cost and Resource Utilization of Expanded Criteria Donor KidneysC. C. Stahl1, K. Wima1, D. J. Hanseman1, R. S. Hoehn1, E. F. Midura1, I. M. Paquette1, S. A. Shah1, D. E.Abbott1 1University Of Cincinnati,Cincinnati, OH, USAScientific Area: Cost Effectiveness Clinical Area: Transplant

Introduction: Despite efforts to increase the deceased donor pool by increased utilization of expanded criteria donor(ECD) kidneys, concerns have been raised about the financial impact and resource utilization of these organs.

Methods: The Scientific Registry of Transplant Recipients database was linked to the University HealthSystemConsortium Database to identify adult deceased donor kidney transplant recipients from 20092012. Patients weredivided into those receiving standard criteria donor (SCD) and ECD kidneys. Length of stay, 30day readmission rates,discharge disposition, and delayed graft function (DGF) were used as indicators of resource utilization. Cost wasdefined as reimbursement based on Medicare cost:charge ratios, and included the costs of readmission whenapplicable.

Results: Of the 19,529 patients in the final dataset (47.6% of the total SRTR deceased donor cohort), 3,495 wereECD recipients (17.9%). ECDs were more likely to be transplanted into older (median age 62 vs 52), male (63.7% vs59.3%) and diabetic recipients (47.1% vs. 31.7%); all p<0.001. On multivariable analysis, ECD kidneys wereassociated with increased 30day readmission (OR: 1.35, CI: 1.211.50) and DGF (OR: 1.33, CI: 1.191.50) but lengthof stay (RR: 1.03, CI: 0.971.09) and discharge disposition (discharge to home, OR: 1.03, CI: 0.781.37) were similarbetween cohorts. There was no difference in total cost (transplant hospitalization+readmission within 30 days) betweenECDs and SCDs (RR: 0.97, CI: 0.931.00, p=0.07).

Conclusion: These data suggest that use of ECDs does not negatively impact shortterm resource utilization and thatECDs can be more broadly utilized without financial consequences.



36.05 ASC20151330

Abandoning Daily Routine Chest Xrays in a Surgical Intensive Care Unit: A Strategy to Reduce CostsS. A. Hennessy1, T. Hranjec2, K. A. Boateng1, M. L. Bowles1, S. L. Child1, M. P. Robertson1, R. G. Sawyer1

1University Of Virginia,Department Of Surgery,Charlottesville, VA, USA 2University Of Texas SouthwesternMedical Center,Department Of Surgery,Dallas, TX, USAScientific Area: Cost Effectiveness Clinical Area: Trauma/Critical Care

Introduction: Chest xray (CXR) remains the most commonly used imaging modality in the Surgical Intensive CareUnit (SICU), especially in mechanically ventilated patients. The practice of daily, routine CXRs is associated withmorbidity for the patient and significantly increased costs. We hypothesized that elimination of routine daily CXRs inthe SICU and integration of clinical ondemand CXRs would decrease cost without any changes in morbidity ormortality.

Methods: A prospective comparative quality improvement project was performed over a 6 month period at a singleinstitution. From November 2013 through January 2014 critically ill patients underwent daily routine CXRs (group 1). From February through April 2014 daily routine CXRs were eliminated (group 2); ICU patients only received a CXRbased on the ondemand CXR strategy. This strategy advised imaging for significant clinical changes or postprocedure. Patients before and after the ondemand CXR strategy were compared by univariate analysis. Parametricand nonparametric univariate testing was used where appropriate. A multivariate logistic regression was performed toidentify independent predictors of mortality.

Results: In total, 495 SICU admissions were evaluated: 256 (51.7%) in group 1 and 239 (48.3%) in group 2. Therewas a significant difference in the number of CXRs, with 4.2 ± 0.7 in the daily CXR group versus 1.2 ± 0.1 in the ondemand group (p<0.0001). The mean cost per admission was $394.8 ± 47.1 in the daily CXR group versus $129.9 ±12.5 in the ondemand group (p<0.0001). This was an estimated cost savings of $60,000 over a 3 month period forgroup 2 compared to group 1. Decreased ICU length of stay (LOS), hospital LOS and mechanical ventilation (MV) wasseen in group 2, while mortality and reintubation rates were equivalent despite decreased imaging (Table 1). Afteradjusting for age, gender, reintubation rate, duration of MV and APACHE III score, no difference in mortality was seenbetween the two groups (OR 2.2, 95% CI 0.76.4, p=0.15). To further adjust for severity of illness, patients withAPACHE III score > 30 were analyzed separately. Mortality and reintubation rate, ICU LOS and hospital LOS weresimilar between the groups, while duration of MV was still decreased (Table 1). In high APACHE III score patientsthere was also a reduction in number of CXR per admission from 4.5 ± 0.8 to 1.4 ± 0.2 with a cost savings of $316.6per ICU admission.

Conclusion: Use of a clinical ondemand CXR strategy lead to a large cost savings without associated increase inmechanical ventilation or mortality. This is a safe and effective quality initiative that will reduce cost without increasingadverse outcomes.



36.06 ASC20150501

Factors Associated with Secondary Overtriage in a Statewide Rural Trauma SystemJ. Con1, D. M. Long1, G. Schaefer1, J. C. Knight1, K. J. Fawad1, A. Wilson1 1West VirginiaUniversity,Department Of Surgery / Division Of Trauma, Emergency Surgery And Surgical CriticalCare,Morgantown, WV, USAScientific Area: Cost Effectiveness Clinical Area: Trauma/Critical Care

Introduction: Rural hospitals have variable degrees of involvement within the nationwide trauma system because ofdifferences in infrastructure, human resources and operational goals. “Secondary overtriage” is a term that has beenused to describe the seemingly unnecessary transfers to another hospital, shortly after which the trauma patient isdischarged home without requiring an operation. An analysis of these occurrences is useful to determine the efficiencyof the trauma system as a whole. Few have addressed this phenomenom, and to our knowledge, we are the first tostudy it in the setting of a rural state's trauma system.

Methods: Data was extracted from a statewide trauma registry from 20032013 to include those who were: 1)discharged home within 48h of arrival, and 2) did not undergo a surgical procedure. We then identified those whoarrived as a transfer prior to being discharged (secondary overtriage) from those who arrived from the scene. Factorsassociated with transfers were analyzed using a logistic regression. Injuries were classified based on the need for aspecific consultant. Time of arrival to ED was analyzed using 8hour blocks, with 7AM3PM as reference.

Results: 19,319 patients fit our inclusion criteria of which 1,897 (9.8%) arrived as transfers. The mean ISS was 3.8 ±3 for nontransfers and 6.6 ± 5 for transfers (p<0.0001). Descriptive analysis showed various other differences betweentransfers and nontransfers due to our large sample size. Thus, we examined variables that had more clinicalsignificance using logistic regression controlling for age, ISS, the type of injury, blood products given, the time of arrivalto the initial ER, and whether a CT scan was obtained initially. Factors associated with being transferred were age>65,ISS>15, transfusion of PRBC’s, graveyardshift arrivals, and neurosurgical, spine, and facial injuries. Orthopedicinjuries were not associated with transfers. Patients having a CT scan done at the initial facility were less likely to betransferred.

Conclusion: Although transferred patients were more severely injured, this was not the only factor driving the decisionto transfer. Other factors were related to the rural hospital’s limited resources, which included the availability ofsurgical specialists, blood products, and overall coverage during the graveyardshift. More liberal use of the CT scanerat the initial facility may prevent unnecessary transfers.



36.07 ASC20150055

Comparing Local Flaps When Treating the Infected Vascular Groin Graft Wound: A CostUtility AnalysisA. Chatterjee1, T. Kosowski2, B. Pyfer2, S. Maddali3, C. Fisher1, J. Tchou1 1University OfPennsylvania,Surgery,Philadelphia, PA, USA 2Dartmouth Medical School,Surgery,Lebanon, NH, USA 3MaineMedical Center,Portland, MAINE, USAScientific Area: Cost Effectiveness Clinical Area: Vascular

Introduction: A variety of options exist in the treatment of the infected vascular groin graft. The vascular and plasticsurgery literature report on using the sartorius and rectus femoris flaps as reasonable coverage options. Both flapoptions incur cost and have variability in success. Given this, our goal was to perform a costutility analysis of thesartorius flap versus the rectus femoris flap in the treatment of an infected vascular groin graft.

Methods: Cost utility methodology involved a literature review compiling outcomes for specific flap interventions,obtaining utility scores for complications to estimate quality adjusted life years (QALYs), accruing costs using DRG andCPT codes for each intervention, and developing a decision tree that could portray the more costeffective strategy.Complications were divided into major and minor categories with major including graft loss with axillaryfemoral bypass,amputation, and death. Minor complications assumed graft salvage after local debridement for partial flap necrosis,seromas and hematomas. The upper limit for willingness to pay was set at $50,000. We also performed sensitivityanalysis to check the robustness of our data. Szilyagi III and Samson III and IV grades of infected groin grafts wereincluded in our study.

Results: Thirty two studies were used pooling 296 patients (234 sartorius flaps, 62 rectus flaps). Decision tree analysisnoted that the rectus femoris flap was the more costeffective option (Figure). It was the dominant treatment optiongiven that it was more clinically effective by an additional 0.30 QALYs with the sartorius flap option costing anadditional $2,241.88. A substantial contribution to these results was due to the sartorius flap having a 13.68% majorcomplication rate versus an 8.6% major complication rate for the rectus femoris flap. Oneway sensitivity analysisshowed that the sartorius flap became a costeffective option if its major complication rate was less than or equal to8.89%.

Conclusion: The rectus femoris flap in the treatment of the infected vascular groin graft is a costeffective optioncompared to the sartorius flap.



36.08 ASC20150650

OneYear Postoperative Resource Utilization in Sarcopenic PatientsP. S. Kirk1, J. F. Friedman1, D. C. Cron1, M. N. Terjimanian1, L. D. Canvasser1, A. M. Hammoud1, J. Claflin1,M. B. Alameddine1, E. D. Davis1, N. Werner1, S. C. Wang1, D. A. Campbell1, M. J. Englesbe1 1University OfMichigan Health System,Department Of Surgery,Ann Arbor, MI, USAScientific Area: Clinical Research (Case Series, Institutional Cohorts)Clinical Area: General Surgery

Introduction: It is well established that sarcopenic patients are at higher risk of postoperative complications andshortterm healthcare utilization. Less well understood is how these patients fare over the long term after surviving theimmediate postoperative period. We explored costs over the postoperative year among sarcopenic patients.

Methods: We identified 1,298 patients in the Michigan Surgical Quality Collaborative (MSQC) database whounderwent inpatient elective surgery at the University of Michigan Health System from 2006 to 2011. Sarcopenia,defined by genderstratified tertile of lean psoas area (LPA), was determined from preoperative CT scans usingvalidated analytic morphomics. Data were analyzed to assess sarcopenia’s relationship to costs, readmissions,discharge location, surgical intensive care unit (SICU) admissions, hospital length of stay (LOS), and mortality.Multivariate models adjusted for patient demographics and surgical risk factors.

Results: Sarcopenia was independently associated with increased adjusted costs at 30, 90, 180, and 365 days(p=0.001, p<0.001, p=0.091, and p=0.021, respectively) (Fig. 1). The difference in adjusted postsurgical costs betweensarcopenic and nonsarcopenic patients increased from $5,541 at 30 days to $9,938 at one year. Sarcopenic patientswere more likely to be discharged somewhere other than home (OR=4.44, CI=2.308.59, p<0.001) and more likely todie in the postoperative year (OR=3.24, CI=1.726.11, p<0.001). Sarcopenia was not an independent predictor ofincreased readmission rates in the postsurgical year (p=0.69).

Conclusion: Sarcopenia is a robust predictor of healthcare utilization in the first year after surgery. These patientsaccumulate costs at a faster rate than their nonsarcopenic counterparts. It may be appropriate to allocate additionalresources to sarcopenic patients in the perioperative setting to reduce the incidence of negative postoperativeoutcomes.



36.09 ASC20150292

The Cost of Secondary Trauma Overtriage in a Level I Trauma CenterD. A. Mateo De Acosta1, R. Asfour1, M. Gutierrez1, S. Carrie2, J. Marshall2 1University Of Illinois College OfMedicine At Peoria (UICOMP),Department Of Surgery,Peoria, IL, USA 2University Of Illinois College OfMedicine At Peoria,Division Of Trauma / Department Of Surgery,Chicago, IL, USAScientific Area: Cost Effectiveness Clinical Area: Trauma/Critical Care

Introduction: The goal of regional trauma systems is to deliver adequate level of care to injured patients in a timelyand cost effective manner. Interfacility transfer of injured patients is the foundation of the United States traumasystems. Patients are commonly secondarily overtriaged delaying their definitive care and posing unnecessary burdenon the receiving institution. Secondary overtriage ranges from 6.9 38%. The financial burden of secondary overtriagingthat is placed on receiving institutions has been rarely studied.

Methods: We reviewed the EMR and trauma registry data of 1200 patients transferred to our institution due totraumatic injuries, during a three year period. Patients were divided in two groups. Group 1 included patients“secondarily overtriaged” and Group 2 (control) those appropriately triaged. Secondary overtriage was defined aspatients transferred from another hospital emergency department to our trauma service with an injury severity score(ISS) < 10, did not require an operation, and were discharged home within 48 hours of admission.

Results: We identified 399 adult patients secondarily overtriaged to our institution. These represented a 31.9% ofthose transferred to our institution during the study period. Common indications for transfer were trauma to the torso,neurological, facial or orthopedic trauma. Main reasons for transfer among those secondarily overtriaged wereTraumatic Brain Injury (37.4%, p<0.05) and Orthopedic Trauma (21.8 %, p<0.05), impacted by the unavailability ofspeialist physcians in the reffering institution. Average hospital cost and reimbursement per overtriaged patient were$19,301 and $7,356.83 respectively. Cost itemization was as follows: Trauma activation $5,016.49, Observationboarding $1,7413, Radiology $ $4,339.09, Laboratory $1,836.68, Pharmacy $1,256.1 and Supplies –$2,431.6.Transport was by ground in 85.95% of patients and via helicopter in 14.05%. Average cost helicoptertransport was $19.535.78.

Conclusion: Secondary trauma overtriage presents a significant burden on trauma centers with an average cost perpatient of approximately $19,301. Major reasons for transfer to our institution were traumatic brain injury andorthopedic mainly due to the unavailability of subspecialty services in the transferring institution. Education of ruraltrauma triage staff must continue to intensify in order to minimize the secondary overtriage of patients, expediting theircare and optimizing resource utilization



36.10 ASC20151194

The True Cost of Postoperative Complications For ColectomyC. K. Zogg1, E. B. Schneider1, J. Canner1, K. S. Yemul1, S. Selvarajah1, N. Nagarajan1, F. Gani1, A. H. Haider1

1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research,Department Of Surgery,Baltimore, MD, USAScientific Area: Health Policy and Healthcare DeliveryClinical Area: General Surgery

Introduction: In 2013, the United States spent $3.8 trillion on healthcare – a number projected to grow by 6.2% peryear. Postoperative complications influence the cost of procedures and guidelines define them as a measure of thequality of surgical care. However, their impact on procedure costs remains obscure. This study explored increased costsassociated with postoperative complications for colectomy using nationally representative data.

Methods: Data from the 20072011 HCUP Nationwide Inpatient Sample were queried for patients ≥18 years of ageundergoing elective procedures with a primary procedure code for laparoscopic or open colectomy. Patients with thefollowing primary diagnoses of colon cancer, diverticulosis, diverticulitis, regional enteritis, ulcerative colitis and benignneoplasm of the colon were included. Patients were assessed for isolated complications including mechanical injury towounds and infection as well as procedural, systemic, urinary, pulmonary, gastrointestinal and cardiovascularcomplications. HCUPdefined weights were used to calculate nationally representative estimates for each complication,stratified by patientdemographic and hospitallevel factors. Diagnosis, procedure and Charlson Comorbidity Index werealso examined. Populationweighted crude and riskadjusted generalized linear models (GLM) were used to assess fordifferences in nonroutine discharge (binomial), inhospital mortality (binomial), length of stay (gamma) and total cost(gamma) (Table).

Results: We identified 115,269 patients of whom 20,728 (17.9%) experienced a postop complication. The mostfrequent complications were gastrointestinal (9.8%) and infectious (3.2%). Patients undergoing laparoscopic proceduresexperienced fewer complications, while patients with colon cancer (19.7%) and ulcerative colitis (18.7%) were at thehighest risk. Adjusted GLM (Table) revealed that patients with complications were >3 times more likely to be nonroutinely discharged and >5 times more likely to die. They had 7782% longer lengths of stay and incurred 7076%higher total costs. Median costs for postoperative complications stratified by primary diagnosis and procedure typewere consistently higher among patients experiencing complications (p<0.001), with an average complication/nocomplication ratio of 1.48/1.00.

Conclusion: The considerable patient and financialburdens associated with postoperative complications emphasizethe need for systemic efforts to support qualityimprovement initiatives and standardized procedures based on bestevidence. Preventing or reducing postoperative complications following colectomy has the potential to dramaticallyreduce overall costs while improving patientcentered outcomes.

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