The High Cost of Delaying Surgery

Delaying elective surgical procedures after a patient has been admitted to the hospital significantly increases the risk of infectious complications and raises hospital costs, according to the results of a study published in the Journal of the American College of Surgeons.

The occurrence of infection following surgical procedures continues to be a major source of morbidity and expense despite extensive prevention efforts that have been implemented through educational programs, clinical guidelines, and hospital-based policies. In this study, Todd R Vogel, MD, MPH, of Robert Wood Johnson Medical School in New Brunswick, NJ, and colleagues queried a nationwide sample of 163,006 patients age 40 years and older from 2003 to 2007. The authors evaluated patients who developed postoperative complications following one of three high-volume elective surgical procedures: 87,318 coronary artery bypass graft (CABG) procedures, 46,728 colon resections, and 28,960 lung resections.

The complications they evaluated included pneumonia, urinary tract infections, postoperative sepsis and surgical site infections. Researchers found that for each type of procedure, infection rates increased significantly from those performed on the day of admission to those performed one, two to five, and six to 10 days later. Total infection rates after CABG increased from 5.7% on the day of admission to 18.2% at six to 10 days, and similar increases were noted after colon resection (from 8.4 to 21.6%) and after lung resection (from 10.2 to 20.6%).

The delays were shown to significantly inflate total hospital costs, they found. The mean cost significantly increased with delays for all procedures evaluated:

• CABG: $36,079 to $47,527;
• Colon resections: $20,265 to $29,887;
• Lung resections: $26,323 to $30,571.

“Multiple factors can contribute to postsurgical complications, including age and coexisting health issues,” said Vogel in a statement. “This analysis, however, confirms a direct correlation between delaying procedures and negative patient outcomes. As pay-for-performance models become increasingly prevalent, it will be imperative for hospitals to consider policies aimed at preventing delays and thereby reducing infection rates.”

Factors associated with in-hospital procedure delays included advanced age (80 years and older), female gender, minority status, and existing health issues including congestive heart failure, chronic pulmonary disease, and renal failure, Vogel and colleagues stated. Postoperative complications most associated with delay in CABG and colon resection were urinary tract infections and pneumonia, while delayed lung resections increased rates of sepsis and pneumonia. Mortality was significantly greater when CABG procedures and lung resections were postponed more than five days.

To access the study, click here.