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Preoperative risk factors and surgical complexity are more predictive of hospital costs than postoperative complications

Patient preoperative risk factors and the complexity of the surgery are more predictive of hospital costs than postoperative complications, according to a study of nearly 6,000 patients undergoing different types of major surgery.

Researchers, supported by the Agency for Healthcare Research and Quality (HS11913), analyzed 60 National Surgical Quality Improvement Program (NSQIP) preoperative risk factors, surgical complexity, patient outcomes, and hospital costs for a random sample of 5,875 patients undergoing 6 surgical services at 1 medical center. They assessed operation complexity by work RVUs (hospital resources used based on the Centers for Medicare and Medicaid Services Resource Based Relative Value Scale). Overall, 51 of the 60 preoperative risk factors, 22 of 29 postoperative complications, and work RVUs were associated with higher variable direct costs. Preoperative risk factors predicted 33 percent of cost variation, work RVUs predicted 23 percent, and complications predicted 20 percent.

Risk factors and work RVUs together predicted 49 percent of cost variation. Adding complications to this combined model only modestly increased prediction of costs by 4 percent for a total of 53 percent.

See "Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications," by Daniel L. Davenport, M.B.A., William G. Henderson, Ph.D., Shukri F. Khuri, M.D., and Robert M. Mentzer Jr., M.D., in the October 2005 Annals of Surgery 242(2), pp. 463-471.

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