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Postoperative complications: how much do they cost?

Complications following major abdominal surgery incur considerable expense. The aims of this study were to analyse prospectively the costs of complications following major abdominal surgery and to compare such costs with those of elective distal large bowel resection. Six patients undergoing elective resection for large bowel cancer were studied at the Royal South Hants Hospital between January and March 1983. The mean cost of resection and primary anastomosis, without postoperative complications, was pounds 1,364 (n = 4). Indirect costs accounted for 38%, nursing 25%, medical staff 13%, investigations 8% and consumables 16%. The operation itself accounted for 12% of the total. Complications following major abdominal surgery were studied in a further ten patients. The costs of complications not prolonging hospital stay were: wound infection pounds 64-146; chest infection pounds 21-27; urinary infection pounds 3-6. Complications prolonging hospital stay resulted in considerably greater cost: pelvic abscess pounds 1245; myocardial infarction pounds 476; subphrenic abscess pounds 857; colostomy retraction pounds 764; wound dehiscence pounds 599; incisional hernia pounds 1723, and major chest infection pounds 258. Owing to high fixed costs, the main factor in determining cost for bowel resection and complications was length of hospital stay.