The Association Between Intra- and Post-Operative Surgical Complications and Clinical and Economic Outcomes in Patients Undergoing Open Right Colectomy in the US

OBJECTIVES: To quantify the association between intra- and post-operative surgical complications and clinical and economic outcomes for patients undergoing open right colectomy in the U.S.

METHODS: Retrospective cohort study using the PINC AI^TM Healthcare Database. The study included patients who underwent inpatient open right-sided colorectal surgery between January 2016 and December 2022 (first=index). Surgical complications included anastomotic leak and bleeding measured at index. Outcomes included postoperative length of stay, total hospital costs, and all-cause 30-day readmissions. Multivariable generalized linear models were used to quantify the association of surgical complications with the study outcomes, adjusting for patient, procedural, hospital, and provider characteristics.

RESULTS: The study comprised 61,466 patients; mean age 65.7 (SD=15.6) years and 55.2% female. Most patients were of white (78.7%) or African American (12.5%) race. The majority of patients had Medicare coverage (60.1%), followed by commercial (25.6%), Medicaid (8.7%), or other (5.6%). The incidence proportions of anastomotic leak and bleeding were 6.3% and 15.4%, respectively. Total hospital costs among patients with evidence of anastomotic leak were 63.5% higher than patients without ($49,582 v $30,317) and 42.1% higher among patients with evidence of bleeding than patients without ($42,014 v $29,564), both p<0.001. The length of stay among patients with evidence of anastomotic leak was 73.8% longer than patients without (15.5 v 8.9 days) and 34.2% longer among patients with evidence of bleeding than patients without (11.9 v 8.9 days), both p<0.001. The 30-day readmission rates among patients with evidence of anastomotic leak were 17.9% higher than patients without (18.7% v 15.9%) and 17.7% higher among patients with evidence of bleeding than patients without (18.3% v 15.6%), both p<0.001.

CONCLUSIONS: In this large retrospective study of patients undergoing open right colectomy in the U.S., surgical complications were common and associated with a significant clinical and economic burden.