Supplementary materials: Impact of surgical complications on hospital costs and revenues: retrospective database study of Medicare claims

These are peer-reviewed supplementary materials for the article 'Impact of surgical complications on hospital costs and revenues: retrospective database study of Medicare claims' published in the Journal of Comparative Effectiveness Research.Figure A1: Comparison of study complication rates to the ACS NSQIP risk calculator average risk of any complication for the procedures of interest.Table A1: Summary of covariates, full dataset and matched dataset. Table A2: Matched dataset balance diagnostics. Standardized mean differences. No complications (control) versus complications.Table A3: Procedures and diagnoses (i.e., complications) groups, ICD10 codes and countsTable A4: Comparison of Study complication rates to ACS NSQIP average risk of any and serious complicationsAim: To compare the length of stay, hospital costs and hospital revenues for Medicare patients with and without a subset of potentially preventable postoperative complications after major noncardiac surgery. Materials & methods: Retrospective data analysis using the Medicare Standard Analytical Files, Limited Data Set, 5% inpatient claims files for years 2016–2020. Results: In 74,103 claims selected for analysis, 71,467 claims had no complications and 2636 had one or more complications of interest. Claims with complications had significantly longer length of hospital stay (12.41 vs 3.95 days, p < 0.01), increased payments to the provider ($34,664 vs $16,641, p < 0.01) and substantially higher estimates of provider cost ($39,357 vs $16,158, p < 0.01) compared with claims without complications. This results on average in a negative difference between payments and costs for patients with complications compared with a positive difference for claims without complications (-$4693 vs $483, p < 0.01). Results were consistent across three different cost estimation methods used in the study. Conclusion: Compared with patients without postoperative complications, patients developing complications stay longer in the hospital and incur increased costs that outpace the increase in received payments. Complications are therefore costly to providers and payers, may negatively impact hospital profitability, and decrease the quality of life of patients. Quality initiatives aimed at reducing complications can be immensely valuable for both improving patient outcomes and hospital finances.

本数据集为发表于《比较疗效研究杂志》之文章《手术并发症对医院成本与收入的影响：基于医疗保险索赔的回顾性数据库研究》的同行评审补充材料。图A1：比较研究并发症发生率与感兴趣手术的ACS NSQIP风险计算器平均并发症风险。表A1：协变量、完整数据集与匹配数据集的概要。表A2：匹配数据集平衡诊断。标准化平均差异。无并发症（对照组）与并发症组。表A3：手术及诊断（即，并发症）分组，ICD10编码及计数。表A4：研究并发症发生率与ACS NSQIP平均任何及严重并发症风险比较。研究目的：比较患有及未患有特定可预防术后并发症的医疗保险患者的住院时长、医院成本及医院收入。研究材料与方法：采用2016-2020年医疗保险标准分析文件、限定数据集、5%住院索赔文件进行回顾性数据分析。研究结果：在分析的74,103份索赔中，71,467份索赔无并发症，2,636份索赔存在一个或多个感兴趣并发症。存在并发症的索赔住院时间显著更长（12.41天 vs 3.95天，p < 0.01），对提供者的支付金额增加（$34,664 vs $16,641，p < 0.01），以及对提供者成本的估算显著提高（$39,357 vs $16,158，p < 0.01），与无并发症的索赔相比。这导致并发症患者的支付与成本之间的平均负差为-$4,693，而无并发症索赔的平均正差为$483（p < 0.01）。研究结果在三种不同的成本估算方法中均保持一致。结论：与无术后并发症的患者相比，出现并发症的患者住院时间更长，且成本增加超过了所收支付的增幅。因此，并发症对提供者和支付者而言代价高昂，可能对医院的盈利能力产生负面影响，并降低患者的生活质量。旨在减少并发症的质量提升措施对于改善患者结果和医院财务具有极大的价值。