EP741 - Association Between Intra- and Post-Operative Surgical Complications and Clinical and Economic Outcomes in Patients Undergoing Left Colectomy in the U.S.

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Purpose/Background: To quantify the association between intra- and post-operative surgical complications and clinical and economic outcomes for patients undergoing left colectomy in the U.S.

Methods/Interventions: Retrospective cohort study using the PINC AI(TM) Healthcare Database. The study included patients who underwent left-sided colorectal surgery between January 2016 and December 2022 (first=index). Surgical complications included anastomotic leak (AL), surgical site infection (SSI), and bleeding measured at index. Outcomes included postoperative length of stay (LOS), 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 (e.g., demographics, surgical indication), procedural (e.g., admission type, surgical approach), hospital (e.g., bed size, teaching status), and provider (e.g., procedure volume, region) characteristics.

Results/Outcomes: The study comprised 197,266 patients; mean age 61.7 (SD=14.0) years and 52.5% female. Most patients were of white (81.6%) or African American (8.7%) race and non-Hispanic ethnicity (76.2%). Diverticular disease was the predominant surgical indication (50.5%), followed by malignancy (28.9%). Approximately half of the surgeries were performed using an open approach (50.8%), 28.0% laparoscopically, 20.6% robotically, and < 1% via natural or artificial opening. The overall incidence proportions of AL, SSI and bleeding were 4.0%, 4.0%, and 11.0%, respectively with an AL/SSI overlap of approximately 25%. Table 1 illustrates how these proportions vary by surgical indication. After multivariable adjustment, the LOS among patients with evidence of AL was 2.2 times longer than patients without (16.3 v 7.5 days), two times longer among patients with evidence of SSI than patients without (15.4 v 7.5 days) and nearly 50% longer among patients with evidence of bleeding than patients without (11.0 v 7.4 days), all p< 0.001. Total hospital costs among patients with evidence of AL were 93.5% higher than patients without ($53,473 v $27,633), more than double among patients with evidence SSI than those without ($58,203 v $27,270), and 50.1% higher among patients with evidence of bleeding than patients without ($40,599 v $27,054), all p< 0.001. The 30-day readmission rates among patients with evidence of AL were 29.1% higher than patients without (17.3% v 13.4%, p< 0.001), the same rate among patients with evidence of SSI and those without (13.6% v 13.6%, p=0.910) and 27.2% higher among patients with evidence of bleeding than patients without (16.7% v 13.1%, p< 0.001).

Conclusion/Discussion: In this large retrospective study of patients undergoing left colectomy in the U.S., we found that while SSI leads to the highest cost among the complications measured, AL leads to longer LOS and a more elevated readmission rate compared to both SSI and bleeding. The continued evolution of evidence-based alternative payment models, such as the Centers for Medicare and Medicaid Services Transforming Episode Accountability Model, requires healthcare stakeholders to have a robust understanding of patient presentation and its influence on total cost of care. This research helps to continue to inform where targeted quality improvement initiatives and innovation in medical technologies may be deployed to reduce complications, improve outcomes and decrease hospital length of stay and need for post-operative care.