TY - JOUR
T1 - Pretreatment patient comorbidity and tobacco use increase cost and risk of postoperative complications after esophagectomy at a high-volume cancer center
AU - Murphy, Caitlin C.
AU - Incalcaterra, James R.
AU - Albright, Heidi W.
AU - Correa, Arlene M.
AU - Swisher, Stephen G.
AU - Hofstetter, Wayne L.
PY - 2013/9
Y1 - 2013/9
N2 - Purpose: Understanding the mechanisms and drivers of cost is a key component of improving the value of cancer care at both the system and patient level. Previous research on the cost of esophagectomy has established important postoperative drivers of cost; however, no study has linked pretreatment patient characteristics with cost. We sought to identify pretreatment patient characteristics that increase inpatient cost, length of stay, and risk of anastomotic leak and major pulmonary event (MPE) after esophagectomy for locally advanced esophageal adenocarcinoma. Methods: We identified 191 patients with locally advanced esophageal adenocarcinoma treated with trimodality therapy at our institution between January 2002 and December 2008. All patients underwent espophagectomy 6 to 8 weeks after completion of neoadjuvant therapy. Multiple linear regression models were used to identify pretreatment predictors of total cost and length of stay. Multivariable logistic regression was used to identify pretreatment factors associated with leak and MPE. Results: Pretreatment comorbidity (β = 0.1215, P = .039) and history of tobacco use (β = 0.0022, P = .028) significantly increased cost of esophagectomy. A comorbid condition increased total cost by 12.9%. Comorbidity (β = 0.2597, P = .001) and poor performance status (β = 0.1514, P = .021) were also significantly associated with prolonged length of stay. Patients with a higher comorbidity score had an increased risk of anastomotic leak (odds ratio, 6.564; 95% CI, 1.676 to 25.716) and MPE (odds ratio, 2.732; 95% CI, 1.317 to 5.666). Conclusion: Pretreatment patient comorbidity and tobacco use increases cost and risk of postoperative complications after esophagectomy. Other institutions must examine the relationship between their own costs and outcomes as cancer care delivery and payment systems become integrated at a national level.
AB - Purpose: Understanding the mechanisms and drivers of cost is a key component of improving the value of cancer care at both the system and patient level. Previous research on the cost of esophagectomy has established important postoperative drivers of cost; however, no study has linked pretreatment patient characteristics with cost. We sought to identify pretreatment patient characteristics that increase inpatient cost, length of stay, and risk of anastomotic leak and major pulmonary event (MPE) after esophagectomy for locally advanced esophageal adenocarcinoma. Methods: We identified 191 patients with locally advanced esophageal adenocarcinoma treated with trimodality therapy at our institution between January 2002 and December 2008. All patients underwent espophagectomy 6 to 8 weeks after completion of neoadjuvant therapy. Multiple linear regression models were used to identify pretreatment predictors of total cost and length of stay. Multivariable logistic regression was used to identify pretreatment factors associated with leak and MPE. Results: Pretreatment comorbidity (β = 0.1215, P = .039) and history of tobacco use (β = 0.0022, P = .028) significantly increased cost of esophagectomy. A comorbid condition increased total cost by 12.9%. Comorbidity (β = 0.2597, P = .001) and poor performance status (β = 0.1514, P = .021) were also significantly associated with prolonged length of stay. Patients with a higher comorbidity score had an increased risk of anastomotic leak (odds ratio, 6.564; 95% CI, 1.676 to 25.716) and MPE (odds ratio, 2.732; 95% CI, 1.317 to 5.666). Conclusion: Pretreatment patient comorbidity and tobacco use increases cost and risk of postoperative complications after esophagectomy. Other institutions must examine the relationship between their own costs and outcomes as cancer care delivery and payment systems become integrated at a national level.
UR - http://www.scopus.com/inward/record.url?scp=84892577490&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892577490&partnerID=8YFLogxK
U2 - 10.1200/JOP.2013.001047
DO - 10.1200/JOP.2013.001047
M3 - Article
C2 - 23943906
AN - SCOPUS:84892577490
SN - 1554-7477
VL - 9
SP - 233
EP - 239
JO - Journal of oncology practice
JF - Journal of oncology practice
IS - 5
ER -