Background: Due to increasing healthcare costs, discussions regarding increased hospital costs when operating on high-risk patients is rising. Therefore, the aim of this study was to analyze if... Show moreBackground: Due to increasing healthcare costs, discussions regarding increased hospital costs when operating on high-risk patients is rising. Therefore, the aim of this study was to analyze if oldest-old colorectal cancer patients have a greater impact on hospital costs than their younger counterparts. METHODS: All colorectal cancer procedures performed in 29 Dutch hospitals between 2010 and 2012 and listed in the Dutch Surgical Colorectal Audit were analyzed. Oldest-old patients (≥85 years) were compared to patients <85 years. Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costs. RESULTS: Compared to <85-year-old patients (n = 9130), the oldest old (n = 783) had longer hospital stays (LOS) (11.3 vs. 13.2, P < 0.001), more severe complications (21.8% vs. 29.0%, P < 0.001), more failure to rescue (13.9% vs. 37.0%, P < 0.001) and higher mortality (3.0% vs. 10.7%, P < 0.001). Deceased oldest-old patients had significantly less LOS and less LOS ICU. Total hospital costs were 3% lower for oldest-old patients (€13,168) than for <85-year-old patients (€13,644, P < 0.001). In cases of severe complications or death, hospital costs for the oldest old were 25% and 31% lower than those of <85-year-old patients (both P < 0.001). CONCLUSION: Although frequently assumed to be more expensive, operating on oldest-old patients with colorectal cancer does not increase hospital costs compared to younger patients. This was most likely due to faster deterioration or less aggressive treatment of oldest-old patients when (severe) complications occurred. Show less
Objective: To compare actual 90-day hospital costs between elective open and laparoscopic colon and rectal cancer resection in a daily practice multicenter setting stratified for operative risk.... Show moreObjective: To compare actual 90-day hospital costs between elective open and laparoscopic colon and rectal cancer resection in a daily practice multicenter setting stratified for operative risk. Background: Laparoscopic resection has developed as a commonly accepted surgical procedure for colorectal cancer. There are conflicting data on the influence of laparoscopy on hospital costs, without separate analyses based on operative risk. Methods: Retrospective analyses using a population-based database (Dutch Surgical Colorectal Audit). All elective resections for a T1-3N0-2M0 stage colorectal cancer were included between 2010 and 2012 in 29 Dutch hospitals. Operative risk was stratified for age (<75 years or 75 years) and ASA status (I-II/III-IV). Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costing. Results: Total 90-day hospital costs ranged from s10474 to s20865 in the predefined subgroups. For colon cancer surgery (N.4202), laparoscopic resection was less expensive than open resection in all subgroups, savings because of laparoscopy ranged from s409 (<75 years ASA I-II) to s1932 (75 years ASA I-II). In patients 75 years and ASA I-II, laparoscopic resection was associated with 46% less mortality (P . 0.05), 41% less severe complications (P < 0.001), 25% less hospital stay (P . 0.013), and 65% less ICU stay (P < 0.001). For rectal cancer surgery (N.2328), all laparoscopic subgroups had significantly higher total hospital costs, ranging from s501 (<75 years ASA I-II) to s2515 ( 75 years ASA III-IV). Conclusions: Laparoscopic resection resulted in the largest cost reduction in patients over 75 years with ASA I-II undergoing colonic resection, and the largest cost increase in patients over 75 years with ASA III-IV undergoing rectal resection as compared with an open approach. Keywords: colorectal cancer, hospital costs, laparoscopy, population based registry, resection, tumor Show less
Govaert, J.A.; Fiocco, M.; Dijk, W.A. van; Scheffer, A.C.; Graaf, E.J.R. de; Tollenaar, R.A.E.M.; ... ; Dutch Value Based Healthcare Study 2015
