Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2020; 26(21): 2682-2690
Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2682
Cost of postoperative complications: How to avoid calculation errors
Roberto De la Plaza Llamas, José M Ramia
Roberto De la Plaza Llamas, José M Ramia, Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
Author contributions: De la Plaza Llamas R and Ramia JM conceived the study and drafted the manuscript; De la Plaza Llamas R design the study and performed the research; Both authors approved the final version of the article.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Roberto De la Plaza Llamas, FACS, MD, MSc, PhD, Associate Professor, Doctor, Surgeon, Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de Sangre s/n, Guadalajara 19002, Spain. rdplazal@sescam.jccm.es
Received: December 27, 2019
Peer-review started: December 27, 2019
First decision: March 27, 2020
Revised: March 27, 2020
Accepted: May 20, 2020
Article in press: May 20, 2020
Published online: June 7, 2020
Abstract

Postoperative complications (PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients’ clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC, improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.

Keywords: Morbidity, Postoperative complications, Costs and cost analysis, Economic evaluation, Healthcare costs, Opportunity cost, Clavien-Dindo classification, Comprehensive complication index

Core tip: No surgery service in the world registers and/or audits the postoperative complications (PC) of all the surgical procedures it performs. Most economic studies of PC are of poor quality; without an accurate registration of PC, their costs cannot be reliably determined. The article describes ways of quantifying and classifying PC, discusses the perspectives from which their economic evaluation and monitoring can be approached, and makes recommendations. An accurate assessment of PC and their costs will allow us to determine which areas need investment in order to lower the incidence of PC, improve surgical results, and reduce economic costs.