Appendix online-only tables - Springer Web view[mp=title, abstract, original title, name of...

Appendix online-only tables

Table A1: List of procedures and complications for which search terms were produced

Surgical

segmentProcedures Surgical complications sought for burden data

Hepatopancreatic

obiliary

Hemihepatectomy

or major liver

resection

Bile leak, intra-abdominal fluid collection or abscess,

haemoperitoneum, incision/wound/surgical site related

complications, surgical site infection

Pancreaticojejuno

stomy

Left (distal)

pancreatectomy

Whipple

procedure

Bile/pancreatic leak, biliary anastomotic leak,

gastroparesis, intra-abdominal fluid collection, need

for drain/redrain/home drain, pancreatic

anastomotic/occlusion failure, pancreatitis,

postoperative pancreatic fistula, subhepatic fluid

collection, vascular anastomosis

Urology Partial

nephrectomy

Urine leakage, urinoma, splenic injury

Radical

prostatectomy

Lymphorrhea, anastomotic leakage,

asymptomatic/symptomatic/infected lymphocele,

obturator nerve injury, ureteral resection, damage of

erectile nerve

Gynaecology Endometriosis

resection

Hysterectomy

Pelvic

lymphadenectomy

Anastomotic/suture leakage (open surgery), anaemia,

bladder perforation/injury, (ureteral, vaginoperitoneal,

vesicovaginal) fistula, lymphedema,

lymphocyst/lymphocele, lymphorrhea, pelvic abscess,

perforation/injury (bowel and bladder) seroma,

ureter/ureteric injury, ureteral stricture, wound

dehiscence

1

Thoracic Lobectomy

(including

bilobectomy)

Atypic lung

resection

Mediastinal lymph

node dissection

(Prolonged) air leak, chest tube drainage,

pneumothorax, incomplete inflation of the lung,

atelectasis, bronchopleural fistula, empyema,

mechanical ventilation, pneumonia, pulmonary

embolism, re-intubation

General All above

procedures

Blood loss, haemorrhage, transfusions required,

haematoma, mortality, haemoglobin changes, post-

operative infection, wound infection/abscess

Table A2: Details of Medline search

SearchesResult

s

1 Cost benefit analysis/ 54191

2 Cost of illness/ 15130

3 Financial management/ 15025

4 Health care cost/ 23216

5 Hospital cost/ 6853

6 cost$.tw. 304563

7

(length and stay).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

68237

8

(duration and stay).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

13840

2

9

(resource adj3 us*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

6569

10

hospitali*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

175950

11 "Costs and Cost Analysis"/ 39817

12 emergency health service/ or emergency care/ 29194

13

(resource* adj3 utili*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

6334

14

(resource* adj2 us*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

10466

15 "length of stay"/ 50773

16 Outpatient Clinics, Hospital/ 13745

17 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 622655

18 exp postoperative complication/ 384246

19 exp Peroperative Complication/ 33253

20 exp Intraoperative Complications/ 33253

21 complication$.mp. 872239

22 adverse event*.mp. 60848

23 18 or 19 or 20 or 21 or 22 1031431

24 bleeding/ 47793

25 abscess/ or subphrenic abscess/ or abdominal abscess/ or pelvis abscess/ or perirenal 24095

3

abscess/

26 wound infection/ or postoperative infection/ or surgical infection/ 8765

27

infection/ or urogenital tract infection/ or lung infection/ or hospital infection/ or lower respiratory tract infection/ or urinary tract infection/ or abdominal infection/ or secondary infection/ or biliary tract infection/

99729

28

(abdominal adj2 collection).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

119

29 injury/ or nerve injury/ or nervous system injury/ or surgical injury/ 82756

30 anemia/ 30951

31 atelectasis/ 5296

32 bacteremia/ 15659

33 intestine injury/ or bowel injury.mp. 743

34 fluid collection.mp. or abdominal abscess/ 3419

35 empyema/ 3352

36 wound dehiscence/ or anastomosis dehiscence/ or dehiscence.mp. 11150

37

(nerve adj3 injur*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

21355

38 hemoperitoneum/ 2635

39 lymphocele.mp. 1094

40 lymphocyst.mp. 123

41 lymphorrhea.mp. 160

42 lymphorrhagia.mp. 19

43 abscess.mp. 60935

4

44 pneumonia/ 34051

45

(resect* adj4 ureter*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

648

46 urinoma/ 50

47 leak*.ti,ab. 64509

48 wound infection/ or wound complication/ 8765

49 stricture*.ti,ab. 18786

50 (failure adj3 anastomo*).ti,ab. 395

51 fistula*.ti,ab. 65647

52 gastroparesis.ti,ab. 1369

53 hematoma/ or hematoma*.ti,ab. 37316

54 haemorrhage.ti,ab. 24240

55 hemorrhage.ti,ab. 87848

56 Lymphedema.ti,ab. 3917

57 lymphoedema.ti,ab. 1434

58 pancreatic occlusion.mp. 5

59 pneumothorax/ 12003

60 Vascular anastomo*.ti,ab. 1529

61 intubation/ 4383

62 Respiration, Artificial/ 35426

63 drain*.ti,ab. 83369

64 Pancreatitis/ 36536

5

65 Peripheral Nerve Injuries/ 3778

66

(bladder or bowel).mp. and injur*.ti,ab. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

10097

67 Intestinal Perforation/ 10185

68 Pulmonary Embolism/ 29224

69 or/24-68 833439

70 hepatectomy.mp. 24025

71 pancreaticojejunostomy/ 727

72 splenectomy/ 17946

73 spleen/ 100257

74 lobectomy/ 454

75 lymph node dissection/ 22329

76 endometriosis/ 15352

77

(excision or resection).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

252300

78 hysterectomy/ 21547

79 76 and 77 1114

80

(hemi-hepatectomy or hemihepatectomy).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

559

81 73 and 77 596

82 (Whipple or Whipple's).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary

3440

6

concept, unique identifier]

83

((nerve sparing or nerve-sparing) and prostatectomy).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

917

84 radical prostatectomy.mp. 11093

85 Pancreatectomy/ 8548

86

(lobe and resect*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

7238

87

(lobectomy and lung).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

5831

88 hemihepatectomy.ti,ab. 514

89 lung resection.mp. 2505

90 Prostatectomy/ 19169

91 Nephrectomy/ 25203

92 Lymph Node Excision/ 22329

93

(liver and resect*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

24089

9470 or 71 or 72 or 74 or 75 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88 or 89 or 90 or 91 or 92 or 93 168416

95 17 and 23 and 69 and 94 1648

96 limit 95 to (humans and yr="2002 -Current" and english) 911

97 (addresses or autobiography or bibliography or biography or case reports or classical article or comment or dictionary or directory or editorial or festschrift or historical article or in vitro or interactive tutorial or interview or lectures or legal cases or legislation or

3488932

7

letter or news or newspaper article or patient education handout or periodical index or portraits or practice guideline or video-audio media or webcasts).pt.

98 96 not 97 880

99limit 98 to ("all infant (birth to 23 months)" or "newborn infant (birth to 1 month)" or "infant (1 to 23 months)" or "preschool child (2 to 5 years)" or "child (6 to 12 years)") 66

100

98 not 99 814

Table A3: Details of Embase search

SearchesResult

s

1 Socioeconomics/ 98811

2 Cost benefit analysis/ 60489

3 Cost effectiveness analysis/ 80602

4 Cost of illness/ 12985

5 Financial management/ 96283

6 Health care cost/109422

7 Health economics/ 30977

8 Hospital cost/ 11949

9 cost$.tw.377088

10(length and stay).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

82026

11(duration and stay).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

27227

12 (resource adj3 us*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name,

8620

8

keyword]

13hospitali*.mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

286668

14 "Costs and Cost Analysis"/ 48041

15 emergency health service/ or emergency care/ 70593

16 outpatient department/ 33910

17(resource* adj3 utili*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

9079

18(resource* adj2 us*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

13388

19 "length of stay"/ 63631

20 exp postoperative complication/429024

21 exp Peroperative Complication/ 16504

22 exp perioperative complication/ 2994

23 complication$.mp.948157

24 exp complication/551710

25(intraoperative adj3 complication*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

9151

26 adverse event*.mp. 90813

27 20 or 21 or 22 or 23 or 24 or 25 or 261248441

28 bleeding/137456

29 abscess/ or subphrenic abscess/ or abdominal abscess/ or pelvis abscess/ or perirenal 34806

9

abscess/

30 wound infection/ or postoperative infection/ or surgical infection/ 63605

31infection/ or urogenital tract infection/ or lung infection/ or hospital infection/ or lower respiratory tract infection/ or urinary tract infection/ or abdominal infection/ or secondary infection/ or biliary tract infection/

243069

32(abdominal adj2 collection).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

170

33 injury/ or nerve injury/ or nervous system injury/ or surgical injury/243702

34 acute pancreatitis/ 14173

35 anemia/ 91840

36 atelectasis/ 9073

37 bacteremia/ 23936

38 nerve paralysis/ 3745

39 bladder injury/ 2087

40 bladder perforation/ 996

41 intestine injury/ or bowel injury.mp. 5662

42 colon injury/ 1474

43 fluid collection.mp. or abdominal abscess/ 7124

44 empyema/ 5891

45 wound dehiscence/ or anastomosis dehiscence/ or dehiscence.mp. 14244

46 nerve injury/ 16363

47(nerve adj3 injur*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

33770

48 hemoperitoneum/ 4231

49 lymphocele.mp. 1812

50 lymphocyst.mp. 160

10

51 lymphorrhea.mp. 238

52 lymphorrhagia.mp. 24

53 abscess.mp. 81823

54 pneumonia/ 84057

55(resect* adj4 ureter*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

810

56 urinoma/ 715

57 leak*.ti,ab. 76141

58 wound infection/ or wound complication/ 27351

59 stricture*.ti,ab. 23645

60 (failure adj3 anastomo*).ti,ab. 483

61 fistula*.ti,ab. 75851

62 gastroparesis.ti,ab. 2074

63 hematoma/ or hematoma*.ti,ab. 52269

64 haemorrhage.ti,ab. 29453

65 hemorrhage.ti,ab.103656

66 Lymphedema.ti,ab. 5081

67 lymphoedema.ti,ab. 1834

68 pancreatic occlusion.mp. 6

69 perforation/ 5930

70 pneumothorax/ 19971

71 lung embolism/ 50825

72 seroma/ 3184

73 Vascular anastomo*.ti,ab. 1737

74 hepatectomy.mp. 16306

75 pancreas resection/ 11917

11

76 pancreaticojejunostomy/ 1408

77 splenectomy/ 24125

78 spleen/ 84939

79 lung lobectomy/ 4419

80 lobectomy/ 4894

81 lymph node dissection/ 15940

82 endometriosis/ 21188

83(excision or resection).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

359312

84 hysterectomy/ 29000

85 hemihepatectomy/ 659

86 82 and 83 1762

87(hemi-hepatectomy or hemihepatectomy).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

1037

88 78 and 83 1222

89 lung resection/ 22791

90 radical retropubic prostatectomy/ 737

91 partial nephrectomy/ 3949

92 pelvis lymphadenectomy/ 2799

93(Whipple or Whipple's).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

3863

94((nerve sparing or nerve-sparing) and prostatectomy).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

1553

95 radical prostatectomy.mp. 16448

96 74 or 75 or 76 or 77 or 79 or 80 or 81 or 84 or 85 or 86 or 87 or 88 or 89 or 90 or 91 or 92 15181

12

or 93 or 94 or 95 9

97 (book or book series or editorial or letter or note or trade journal).pt.1792209

98 liver resection/ 24499

99 96 or 98165507

100

1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19

1094940

101

28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 or 72 or 73

1267857

102

drain*.ti,ab.100384

103

artificial ventilation/ 70234

104

intubation/ 13496

105

101 or 102 or 103 or 1041393836

106

27 and 99 and 100 and 105 4121

107

limit 106 to (human and yr="2002 -Current") 2808

108

107 not 97 2742

109

limit 108 to (embryo <first trimester> or infant <to one year> or child <unspecified age> or preschool child <1 to 6 years> or school child <7 to 12 years>)

151

110

108 not 109 2591

13

111

limit 110 to english 2398

Table A4: Details of Econlit search

SearchesResul

ts

1 complication$.mp. 554

2 injury*.mp. [mp=heading words, abstract, title, country as subject] 894

3 anemia.mp. [mp=heading words, abstract, title, country as subject] 37

4 atelectasis.mp. [mp=heading words, abstract, title, country as subject] 0

5 bacteremia.mp. [mp=heading words, abstract, title, country as subject] 0

6 empyema.mp. [mp=heading words, abstract, title, country as subject] 0

7 dehiscence.mp. [mp=heading words, abstract, title, country as subject] 0

8 anastomo*.mp. [mp=heading words, abstract, title, country as subject] 0

9 hemoperitoneum.mp. [mp=heading words, abstract, title, country as subject] 0

10

lymphocele.mp. [mp=heading words, abstract, title, country as subject] 0

11

lymphocyst.mp. [mp=heading words, abstract, title, country as subject] 0

12

lymphorrhea.mp. [mp=heading words, abstract, title, country as subject] 0

13

lymphorrhagia.mp. [mp=heading words, abstract, title, country as subject] 0

14

pneumonia.mp. [mp=heading words, abstract, title, country as subject] 48

1 urinoma.mp. [mp=heading words, abstract, title, country as subject] 0

14

5

16

leak*.mp. [mp=heading words, abstract, title, country as subject] 700

17

wound.mp. [mp=heading words, abstract, title, country as subject] 25

18

stricture*.mp. [mp=heading words, abstract, title, country as subject] 55

19

failure.mp. [mp=heading words, abstract, title, country as subject] 9995

20

fistula*.mp. [mp=heading words, abstract, title, country as subject] 3

21

gastroparesis.mp. [mp=heading words, abstract, title, country as subject] 0

22

hematoma.mp. [mp=heading words, abstract, title, country as subject] 1

23

haemorrhage.mp. [mp=heading words, abstract, title, country as subject] 4

24

hemorrhage.mp. [mp=heading words, abstract, title, country as subject] 8

25

Lymphedema.mp. [mp=heading words, abstract, title, country as subject] 0

26

lymphoedema.mp. [mp=heading words, abstract, title, country as subject] 0

27

occlusion.mp. [mp=heading words, abstract, title, country as subject] 2

28

pneumothorax.mp. [mp=heading words, abstract, title, country as subject] 1

29

intubation.mp. [mp=heading words, abstract, title, country as subject] 0

30

ventilation.mp. [mp=heading words, abstract, title, country as subject] 28

15

31

drain*.mp. [mp=heading words, abstract, title, country as subject] 974

32

Pancreatitis.mp. [mp=heading words, abstract, title, country as subject] 0

33

Perforation.mp. [mp=heading words, abstract, title, country as subject] 1

34

Pulmonary Embolism.mp. [mp=heading words, abstract, title, country as subject] 6

35

adverse.mp. [mp=heading words, abstract, title, country as subject] 6704

36

1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35

19727

37

surger*.mp. 304

38

surgical.mp. 212

39

procedure*.mp. 19956

40

operat*.mp. 35783

41

resect*.mp. 4

42

laparotom*.mp. 0

43

laparoscop*.mp. 4

44

robot.mp. 76

45

37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 54615

16

46

36 and 45 1506

47

limit 46 to (yr="2002 -Current" and english) 944

48

limit 47 to (books or book reviews) 26

49

47 not 48 918

17

Table A5: Costs associated with HPB surgery

Study Comparison group n Currency/cost year¶

Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]

PancreaticoduodenectomyDaskalaki, 2011 No POPF 408 EUR‡/NR

(1996)tests and radiological investigations: 179.6

Operating theatre: 3,567.58

Hospital stay:3600radiological imaging:80Laboratory:472.8

1994.48 9665.56 [17886.09]

Grade A POPF 28 tests and radiological investigations: 179.6


Hospital stay:4,950radiological imaging:80Laboratory:472.8

2404.99 11654.97 [21567.48]

Grade B POPF 104 tests and radiological investigations: 179.6


Hospital stay:10,800Transfusions:70Total parenteral or enteral nutrition:1,540Octreotide:241.65radiological imaging:897Laboratory:1,141.25

5302.81 25698.24 [47554.52]

Grade C POPF 13 tests and radiological investigations: 179.6


Hospital stay:20,700Intensive care:6500Reoperation:2000Transfusions:280

12,276.25 59492.64 [110090.96]

18



Total parenteral or enteral nutrition:3,700Octreotide:483.3radiological imaging:1,674Laboratory:1,815.20

Fuks, 2009 - - - - - - - -Haddad, 2009 - - - - - - - -Topal, 2007 All patients 109 EUR †/NR

(2005)- - - - 10406 (5570 - 30999)

[16325 (8738-48634)]Patients with post operative pancreatic fistula (POPF)

14 - Operation room: 2264 (1007-6475)

Hospital stay: 4847 (520-7956)Intensive care: 0 (0-3667)Emergency: 0(0-87)Functional measurement: 0 (0-227)Imaging: 142 (0-512)Laboratory: 1164 (707-9712)Medical Staff (unspecified): 2057 (1296-5132)Paramedical personnel: 259 (0-1035)Pharmacy: 3140 (2008-7298)Care logistics: 53 (53-159)

- 15225 (10171-30685) [23886 (15957-48141)]

Patients with complications other than POPF

37 - Operation room: 2199 (1002-5079)

Hospital stay: 3639 (1213-13493)Intensive care: 0 (0-7215)Emergency: 0 (0-499)Functional measurement: 33 (0-821)Imaging: 109 (0-685)Laboratory: 877 (412-5147)Medical Staff (unspecified): 1950 (1301-5750)Paramedical personnel: 194

- 11393 (6716- 30999) [17874 (10536-48634)]

19



(0-1805)Pharmacy: 1526 (500-5871)Care logistics:0 (0-499)

Patients without complications

58 - Operation room: 2131 (970-6425)

Hospital stay: 2686 (1213-7358)Intensive care: 0 (0-1467)Emergency: 0 (0-673)Functional measurement: 0 (0-227)Imaging: 53 (0-289)Laboratory: 640 (277-2206)Medical Staff (unspecified): 1735 (1158-3060)Paramedical personnel:0 (0-776)Pharmacy: 978 (460-4340)Care logistics: 0 (0-673)

- 8565 (5569-16921) [13437 (8737-26547)]

Patients with grade 1 TOSGS-score of complication

2 - - - - 7696 (7013-8378) [12074 (11002-13144)]


NR - - - - NR


2 - - - - 19355 (8026-30685) [30366 (12591-48141)]

Vanounou, 2007§

All patients NR US $/NR (2007)

- - - - NRNo pancreatic fistula or other complication

167 - - - - 18,254 [21,357]

Any grade of fistula NR - - - - NRGrade A pancreatic fistula

26 - - - - 18,235 [21,334]

Grade B pancreatic fistula

28 - - - - 30,581 [35,779]

20



Grade C pancreatic fistula

6 - - - - 113,084 [132,308]

Pancreatic resectionCasadei, 2011 - - - - - - - -Glowka, 2010 - - - - - - - -Jimenez, 2007 - - - - - - - -Rodriguez, 2006 Pancreatic stump

leak (PL) related complications

22 US $/NR (2004)

- - - - The average patient with PL-related problem incurred a total cost that was 2.01 times greater than the average patient in the no-PL group. This yielded a cost differential of $14,179 [17,581], which was largely accounted for by hospital-related costs. A decision analytic model developed to evaluate threshold costs showed that a hypothetical intervention designed to reduce the complication rate of distal pancreatectomy by one third would be financially justifiable up to a cost of $1418 [1758] per patient. Alternatively, an intervention that reduced PLs to 0% could cost up to $4254 [5274] and still be economically justified. Many of the PLs were manifesting as both a fistula and a sterile collection, or a fistula

21


Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]and an abscess.

Simons, 2009 - - - - - - - -Pancreaticoduodenectomy and Pancreatectomy (Mixed populations)Behrman, 2008 - - - - - - - -Belyaev, 2011 - - - - - - - -Kent, 2011§ All patients 578 US $/NR

(2009)- - - - Initial admission: NR

No readmission within 30 days (all resection types)

467 - - - - Initial admission (total cost): 24,679 [26,900]

30-Day readmitted patients (all resection types)

111 - - - - Initial admission: 30,988 [33,776]Readmission: 10,159 [11,073]Overall Hospital costs (initial surgery + readmissions): 40,583 [44,235]

Pratt, 2009 All patients 405 US $/NR (2008)

- - - - NR‘No relevance’ (patients who either lacked evidence of fistula or demonstrated biochemical evidence alone)

349 - - - - Total, including readmission cost:17556 (IQR 15176–22071) [19312 (IQR 16694-24278)]

Evident fistula 36 - - - - Total, including readmission cost:23542 (IQR 17337–43640) [25896 (IQR 19071-48004)]

Latent Fistula 20 - - - - Total, including readmission cost:31750 (IQR 20907–47743) [34925 (IQR 22998-52517)]

Type I: subacute 6 - - - - Total, including

22



latent pancreatic fistula

readmission cost:22873 (IQR 17508–30248) [25160 (IQR 19259-33273)]

Type II: acute latent pancreatic fistula


Type III: critical latent pancreatic fistula


Hepatic resectionBreitenstein, 2010

All patients 615 US $/NR (2009)

- - - - 35,028 (IQR 25,572-51,338) †, 51,497 (59,418) ‡ [38531 (IQR 28129-56472) 56647 (65360)]

no complications, or Grade I or II complications

456 - - - - 31,669 (IQR 24,019-40,795) †, 36,931 (27,854) ‡ [34836 (IQR 26421-44875) 40624 (30639)]

grade III or IV complications

159 - - - - 65,228 (IQR 43,130-98,811) †, 94,545 (96,252) ‡ [71751 (IQR 47443-108692) 104000 (105877)]

Score 0-2 (low-risk of postoperative complications)

NR - - - - 32,371 (IQR 24,174-42,830) †, 43,247 (46,991) ‡ [35608 (IQR 26591-47113) 47572 (51690)]

Score 3-5 NR - - - - 35,194 (IQR 26,426-

23



(intermediate risk of postoperative complications)

53,597) †, 51,940 (51,295) ‡ [38713 (IQR 29069-58957) 57134 (56425)]

Score 6-10 (high risk of postoperative complications)

NR - - - - 62,210 (IQR 41,245-89,362) †, 86,863 (99,215) ‡ [68431 (IQR 45370-98298) 95549 (109137)]

Abbreviations: NR, not reported†Median (range), or Median (interquartile range) values reported ‡Mean (sd) or mean (range) reported §Further data is extracted in the accompanying DET file ¶ Where the cost year is not reported, the year of data collection (or end thereof for ranges) was used (provided in brackets)

24

Table A6: Resource use associated with HPB surgery

Study Comparison group

n Hospital stay (days)

ICU days/visits

Re-operation Blood transfusion Medication use Tests/Diagnosis Other

PancreaticoduodenectomyDaskalaki, 2011 No POPF 408 8 - - - - - -

Grade A POPF 28 11 - - - - - -Grade B POPF 104 24 - - - - - -Grade C POPF 13 46 - - - - - -All patients with POPF

147 19 (IQR 14-27.5)

- 17 (11.6%)Time to reoperation:12 days (IQR 12–16.5) from the PDpercutaneous drainage US-CT guided for intra-abdominal collections: 5 (3.4%)endoscopic procedure due to hematemesis: 1 (0.7%)

- - - -

Fuks, 2009 All patients 680 NRAll pancreatic fistula patients

111 NR; mean duration of drainage output was 13 (11) days (range 4–45).

- - 9 (11%) - - -

Grade A/B pancreatic fistula

75 29 (9) - required percutaneous drainage for intra-abdominal collection : 7

21 (30.8%) all Grade B patients treated with total parenteral nutrition: 32somatostatin analogues: 75%

- -


36 46 (16) - reoperation in 35 (97%):for intra-abdominal collections: 7emergency surgery for hemodynamic instability: 2reoperation with isolated

16 (51.6%) somatostatin analogues: 73%

Angiography with embolization: 2

-

25



ICU days/visits


elective haemostasis for bleeding: 14

surgical pancreatic drainage: 17percutaneous drainage: 7

Haddad, 2009 All patients 117 NR - NR Intra-operative, Red blood cells units: 0.7 (0–12)

- - -

No pancreatic fistula

82 21 (9) - 0 Intra-operative, Red blood cells units: 0.6 (0–5)

- - -

PF treated conservatively

21 42 (17.5) - 0 Intra-operative, Red blood cells units: 0.7 (0–4)

- - -

PF treated surgically (relaparotomy)

14 63 (27) - All patients were reoperated (relaparotomy); completion splenopancreatectomy: 5debridement and drainage: 9

Intra-operative, Red blood cells units: 0.7 (0–12)

- - -

Topal, 2007 All patients 109 17 (7-52) † 2 (1.8%) 6 (5.5%) - prophylactic octreotide was based on the judgment of the surgeon, mainly in patients with soft pancreatic texture. Octreotide administered with the intention to treat in 12/14 patients with POPF for 7 (5-16) days.

- -

Patients with Post operative

14 26 (10-36) † - - - - - -

26



ICU days/visits


pancreatic fistula (POPF)Patients with complications other than POPF

37 21 (8-52) † - - - - - -


58 14 (7-33) † - - - - - -


2 15 (15-15) † - - - - - -


2 30 (29-31) † - - - - - -


2 NR - - - - - -

Vanounou, 2007 All patients 227 10 - - - - - -No pancreatic fistula or other complication

167 9.3 - - - - - -

Any grade of fistula 60 NR; but 6 (2.6%) were readmitted

- Reoperation: 3 (1.3%)percutaneous drainage: (6.7%).

- supplemental nutrition: 15 patients (25.0%)Antibiotics: 26 (43.3%)

- -

Grade A pancreatic fistula

26 8.2 - - - - - -

Grade B pancreatic fistula

28 12 - - - - - -


6 29.7 - - - - - -

Pancreatic resectionCasadei, 2011 All patients 61 12.7 [7-118] - - - - - -

No complication 30 9.2(2.2) - - - - - -Grade I 9 10.4(3.0) - - - - - -

27



ICU days/visits


complicationsGrade II complications

15 12.3(4.7) - - - - - -

Grade III complications

6 16.8(9.4) - radiologic intervention not under general anaesthesia: 6 (all patients)

- - - -

Grade IV complications

1 118 Intensive care visit: 1

underwent surgery under general anaesthesia: 1

- - - -

Glowka, 2010 All patients 53 21 (7-153) - NR - - - -No redo surgery 43 18 (7-126) - 0 - - - -Early redo surgery 6 40 (8-126)(initial

stay)6 (readmission)

- 6 - - - -

late redo surgery 4 22 (10-43)(4 readmissions)

- 4 - - - -

Jimenez, 2007 All patients 31 - - - - - - -Control group - stapled (non reinforced)

18 - - Reoperation for leak: 1interventional radiology drainage for leak: 3

- - - surgical drains retained:2

Experimental group - staple line reinforcement

13 - - Reoperation for leak: 0 - - - surgical drains retained:0

Pancreatic leak 7 13.6 (5–28) - Reoperation for leak: 1interventional radiology drainage for leak: 3

- - - surgical drains retained:2

No pancreatic leak 24 8.33 (5–21) - Reoperation for leak: 0 - - - surgical drains retained:0

Rodriguez, 2006 All patients 66 - - 3 (5%) - - - -Pancreatic stump leak (PL) related complications

22 Total (initial + readmission): 16.6(14.6) [4-49 days]

Readmitted: 16 (73%); 13.8 (1-38) days length

- 1: reexplored at 90 days for persistent intra-abdominal abscess.1: Another, who had splenic preservation, underwent reexploration at 3.5 months for splenic infarct and persistent

- Broad spectrum antibiotics (at least one course): 15 (68%), for an average of 12.6 days (range, 7-24 days)

- Emergency room visits: 13 (59%), mean no. of visits: 1.8 (1-6)

visiting nurse services for their postoperative

28



ICU days/visits


of stay for readmission; mean no. of readmissions 1.7 (1-5)

collection in the splenic hilum. care:18 (82%)

'Office visits': 4.9 (1-20)

Duration of follow-up: 69.5 (14-347)

interventional radiology drainage: 12 (55%); No.; interventional radiology drainage per patient: 1.1 (0-5)computed tomographic scans Postoperatively: 4.6 (0-15)

No Pancreatic stump leak (No-PL)

44 Total: 5.2(1.7) [3-12 days]Readmitted: 0 (0%)

-underwent reexploration for presumed splenic infarct but required no further intervention.

- - - Emergency room visits: NRvisiting nurse services for their postoperative care:3 (7%)'Office visits': 1.6 (1-6)

Duration of follow-up: 16.0 (8-128)

Simons, 2009 - - - - - - - - -Pancreaticoduodenectomy and Pancreatectomy (Mixed populations)Behrman, 2008 All patients 169 - - - - - - -

Patients with 32 28.5 - 21/ 32 patients had 1 - - - Multiple drains: 7

29



ICU days/visits


postoperative Intra-abdominal sepsis

procedure alone, but 11(34%) required multiple procedures:Percutaneous drainage (PD): 27open operative drainage to eradicate the septic focus: 10Operative drainage (OD) after failed Percutaneous drainage: 4Additionally,open surgical drainage to eradicate the septicfocus needed for 4 of 21 (19%) developing infection (abscess) on or after postoperative day 7.

Perioperative octreotide:30 (93.8)

Patients with No postoperative Intra-abdominal sepsis

164 15.2 - - - - - Perioperative octreotide:109 (66.5)

Belyaev, 2011 All patients 696 14 (1-158) Length of stay: 1 (1-111)

NR - - - -

Patients who developed clinically significant POPF

25 26 (15-100) Length of stay: 5 (1-92)

8 (32%) - - - -

Patients who did not develop a pancreatic leak (control)

25 14 (8-38) Length of stay: 1 (1-5)

2 (8%) - - - -

Kent, 2011 All patients 578 8 - - - - - -No readmission within 30 days (all resection types)

467 8 days (total stay)

- - - - - No. (%) with: any complications: 217 (46.9)Major complications: 50 (10.8)Pathway

30



ICU days/visits


deviation: 166 (35.9)Clinically relevantpancreatic fistula: 37 (8)Delayed gastricEmptying: 21 (4.5)Wound infection: 55 (11.9)MyocardialInfarction: 9 (1.9)Pneumonia: 28 (6.1)Acute renal failure: 7 (1.5)

30-Day readmitted patients (all resection types)

111 8 days initial stay and23 (21%) with multiple readmissions within the first 30 days after theoriginal discharge. Readmission stay: 7 daysTotal days: 15

- - - - - No. (%) with: any complications: 84 (76.4)Major complications: 34 (30.9)Pathway deviation: 65 (60.8)Clinically relevantpancreatic fistula: 40 (36.4)Delayed gastricEmptying: 13 (11.8)Wound infection: 26 (23.6)MyocardialInfarction: 1 (0.9)Pneumonia: 9 (8.2)Acute renal

31



ICU days/visits


failure: 3 (2.7)Pratt, 2009 All patients 405 NR 13 (3.7%) - - - - -

‘No relevance’ (patients who either lacked evidence of fistula or demonstrated biochemical evidence alone)

349 Initial: 8 (IQR 7–8)n(%) readmitted: 35 (10.0)Total stay: 8 (IQR 7–9)

2 (6%) CT-guided percutaneous drainage: NRSurgical exploration: NR

45 (12.9) Supplemental parenteral nutrition: 28 (8.0)Antibiotics: 76 (21.8)

discharged to Rehabilitation facilities, n(%): 35 (10.1)

Evident fistula 36 Initial: 9 (IQR 7–15)n(%) readmitted: 13 (36)Total stay: 14 (IQR 8–20)

5 (25%) CT-guided percutaneous drainage: 9Surgical exploration: 2

12 (33) Supplemental parenteral nutrition: 9 (25)Antibiotics: 25 (69)

discharged to Rehabilitation facilities, n(%): 12 (34)

Latent Fistula 20 Initial: 10 (IQR 8–18)n(%) readmitted: 12 (60)Total stay: 20 (IQR 13–26)

1 CT-guided percutaneous drainage: 7Surgical exploration: 7

11 (55) Supplemental parenteral nutrition: 8 (40)Antibiotics: 15 (75)

discharged to Rehabilitation facilities, n(%): 6 (30)

Type I: subacute latent pancreatic fistula

6 Initial: 8n(%) readmitted: 5Total stay: 8

1 CT-guided percutaneous drainage: 5Surgical exploration: 2

- - - Time to removal of intra-abdominal drain: 7 (IQR 6–9)presented to an outpatient surgical clinic on day 32 after surgery (18 days after hospital discharge) with copious fluid emerging from her drain, which had beenplaced during surgery: 1

32



ICU days/visits


Type II: acute latent pancreatic fistula

8 Initial: 8n(%) readmitted: 7Total stay: 23

3 CT-guided percutaneous drainage: 1Surgical exploration: 3required reoperation: 1 (pancreaticojejunostomy repair)

- - - Time to removal of intra-abdominal drain: 7 (IQR 6–7)

Type III: critical latent pancreatic fistula

6 Initial: 19n(%) readmitted: 0Total stay:19

13 (3.7) CT-guided percutaneous drainage: 1Surgical exploration: 2required reoperation for definitive management of fistula: 2

- - - Time to removal of intra-abdominal drain: 36 (IQR 18–50)

Hepatic resectionBreitenstein, 2010 All patients 615 11 (IQR 9-17)† 1 (IQR 0-2)† - 2 (2-4) † §

(intraoperative)- - -

no complications, or Grade I or II complications

456 11 (IQR 9-13)† 1 (IQR 0-1)† - 2 (1-4) † §


grade III or IV complications

159 22(IQR 15-31)† 3 (IQR1-8)† - 3 (2-6) † §


Score 0-2 (low-risk of postoperative complications)

- - - - - - - -

Score 3-5 (intermediate risk of postoperative complications)

- - - - - - - -

Score 6-10 (high risk of postoperative complications)

- - - - - - - -

†Median (range), or Median (interquartile range) ‡Mean (sd) or mean (range) §Units for transfusions not reported, presumed to be ‘blood units’, per person.

Table A7: Costs associated with Urology surgery

33

Study Comparison group n Currency/cost year†


Radical prostatectomyBartsch, 2008 - - - - - - - -Guillonneau, 2003

- - - - - - - -

Treiyer, 2009 - - - - - - - -Yu, 2012 All patients 11513

(propensity adjusted and weighted)

US $/NR (2008)

- - - - -

With any complications

NR - - - - Mean cost per patient with any complication:For a complicated patient with a length of stay <2 days duration: US $10,267 [11,191]For a complicated patient with a length of stay ≥2 days duration: US $17,245 [18,797]

Without complications

NR - - - - Mean cost per patient with any complication:For a complicated patient with a length of stay <2 days duration: US $7,233 [7,883]For a complicated patient with a length of stay ≥ 2 days duration: US $9,240 [10,071]

†Where the cost year is not reported, the year of data collection (or end thereof for ranges) was used (provided in brackets)

34

Table A8: Resource use associated with Urology surgery


N/n Hospital stay (days)

ICU days

Re-operation Blood transfusion

Medication use Tests/Diagnosis Other

Radical prostatectomyBartsch, 2008 All patients 148 Most patients

were hospitalized for 10–14 days after surgery

- - - - - -

Patients with bacteriuria/UTI

66 (Cases) - - - - For 66 cases of bacteriuria/UTI in 48 patients:The most often orally administered antibiotics for bacteriuria/UTI in this study were trimethoprim/sulfamethoxazole (44.6%), levofloxacin (29.8%), and cefuroxime axetile (20.7%), while cefotaxime, ciprofloxacin, and piperacillin/tazobactam were administered in single cases only.

- Time to removal of indwelling catheter: 17 days

Patients without bacteriuria/UTI

82 - - - - - - Time to removal of indwelling catheter:15 days

Guillonneau, 2003

All patients NA - - - - - - -

Patients with rectal injury

13 For 9 patients with an uneventful immediate postoperative course and mean hospitalstay was 6.8 days

- rectal injury diagnosed intraoperatively and primary repair was performed laparoscopically: 11/13Exploratory laparotomy for

- - - Patients withfailed primary repair (2) or delayed diagnosis of the rectalinjury (2) had a urethral catheter for 12,

35



ICU days



Patients withfailed primary repair (2) or delayed diagnosis of the rectalinjury (2) hadhospital stay of 7, 16, 21 and 27 days, respectively.

patients, who had undergone closure of the 1-layer rectal injury intraop: 2/13

Colostomy: 3/13perineal repair required for rectourethral fistula: 1

13, 15 and 120 days.

8.6 days urethral catheter (range 5 to 10) for 9 patients with uneventfulimmediate postoperative course

indwelling bladder drainage for 3 months: 1/13 (for rectourethral fistula formation)

Treiyer, 2009 Patients with Persistent symptomatic pelvic lymphoceles after PCD

15 - - For patients with Persistent symptomatic pelvic lymphoceles after PCD (n=15):percutaneous catheter drainage and sclerotherapy: 7 (46.7)Laparoscopic marsupialization of pelvic lymphoceles after a failed combined

- - - -

36



ICU days



PCD-sclerotherapy: 3 (20.0)Laparoscopic marsupialization of pelvic lymphoceles without using sclerotherapy: 4 (26.7)Open laparotomy: 1 (6.6)

Yu, 2012 All patients 2348 after incorporating NIS survey weights

1.7 (3.0) - - - - - No. of patients discharged home, n(%):94.9%

Patients with complications

NR - - - - - - -


NR - - - - - - -

Table A9: Costs associated with gynaecological surgery



HysterectomyAaronson 2011 All patients 96,386 US $/NR

(2007)- - - - -

Patients without non-infectious urethral related complication

96,355 - - - - -

Patients with non-infectious urethral

31 - - - - -

37

related complicationCoello 2005 patients without

Surgical site infections

NR UK £/2003 - - - -

patients with SSI (all SSI types)

168 SSI - - - - £959 [2001] additional cost per patient compared to no SSI

patients with superficial incisional SSI


Patients with either Deep incisional or organ/space SSI


Duong 2009 Patients with VVF 4 - - - - -Patients without VVF

30 - - - - -

Gunnarsson 2009

Patients with nosocomial infections post laparoscopic hysterectomy

4,783 US $/NR (2006)

- - - - Patients with nosocomial infections post laparoscopic hysterectomy increased their hospital costs by an average of $4528 [5297]

Rotermann 2004 All patients receiving hysterectomy

159,644 $ Canada/ Alberta: 2000/01; Ontario: 1999/2000

- - - - -

Uninfected patients 156,390 - - - - -Infected patients 3,254 - - - - Total cost for

readmissions ranged from $4,406 - $5,088 [5,301 – 6,122]. Estimated to have an annual cost due to infection readmissions of $2.26 to $2.61 million [2.71 – 3.14].

Mixed population (Hysterectomy with other gynaecological procedures)De Lissovoy All Obstetric and

gynaecologic 269,041 $ US/NR - - - -

38

2009 patients (2005)Without surgical site infection: from database

268,733 - - - - Mean total hospital cost per patient of $5457 [6,908]

With surgical site infection: from database

159 - - - - Mean total hospital cost per patients with a surgical site infection was $19,425 [24,591] which was $13,968 [17,683] greater than a patient infection-free.

With surgical site infection: Projected national impact

772 - - - -


Table A10: Resource use associated with gynaecological surgery

Study Comparison group N/n Hospital stay (days)

ICU days Re-operation Blood transfusion Medication use Tests/ Diagnosis Other

HysterectomyAaronson 2011 All patients 96,386 - - - - - - -

Patients without non-infectious urethral related complication

96,355 2.6 - - - - - -

Patients with non-infectious urethral related complication

31 4.3 - - - - - -

Coello 2005 All patients 6789 (operations not patients)

- - - - - - -

39



patients with SSI (all SSI types)

3.3 (2.7–4.0) additional hospital days compared to no SSI

- - - - - -

patients with superficial incisional SSI

2.8 (2.2–3.5)additional hospital days compared to no SSI

- - - - - -

Patients with either Deep incisional or organ/space SSI

6.7 (4.7–8.9)additional hospital days compared to no SSI

- - - - - -

Duong 2009 Patients with VVF 4 8.5 (SE: 2.9) days

- - 25% patients - - Mean operating time was 376 (SE: 126) min Indwelling catheter use 10.5 (SE: 3.5) days

Patients without VVF

30 3.9 (SE: 0.6) days

- - 30% patients - - -mean operating time 209 (SE: 18) min-indwelling catheter use 8.5 (SE: 0.4) days

Gunnarsson 2009

Patients with nosocomial infections post laparoscopic hysterectomy

4783 Patients with nosocomial infections post laparoscopic hysterectomy increased their length of hospital stay by average of 2.52

- - - - - -

40



daysRotermann 2004

Uninfected patients 156,390 4.2 days (includes hospital stay and readmissions)

- - - - - -

Infected patients 3254 10.6 days (includes initial stay and readmissions)

- - - - - -

Mixed population (Hysterectomy with other gynaecological procedures)De Lissovoy 2009

All Obstetric and gynaecologic patients

269,041 - - - - - -

Without surgical site infection: from database

159 (matched pts with no infection)

4.8 - - - - - -

With surgical site infection: from database

159 10.8 - - - - - -

41

Table A11: Costs associated with thoracic surgery


Preoperative Intraoperative Postoperative Indirect costs Total hospital costs[2013 US$]

Lobectomy/bilobectomyHandy, Jr, 2011 Uncomplicated

(lobectomy)222 US $/NR

(2007)- - - - Total hospital costs

(initial admission); Mean total hospital cost per patient: $18,449 [21,031]

Complications or Death (lobectomy)

46 - - - - Total hospital costs (initial admission); Mean total hospital cost per patient: $39,250 [44,745]

Liberman, 2010 Overall study population

- - - - - - -

Prolonged air leak - - - - - - -Control (700 consecutive patients)

- - - - - - -

Okereke, 2005 All patients - - - - - - -Air leak - - - - - - -No air leak - - - - - - -

Seely, 2010 Lobectomy patients - - - - - - -Lobectomy patients with Grade I complications

- - - - - - -

Lobectomy patients with Grade II complications

- - - - - - -

Lobectomy patients with Grade IIIa complications

- - - - - - -

Lobectomy patients with Grade IIIb complications

- - - - - - -

Lobectomy patients - - - - - - -

42



with Grade IVa complicationsLobectomy patients with Grade IVb complications

- - - - - - -

Stolz, 2005 All patients - - - - - - -Non Prolonged air leak

- - - - - - -

Prolonged air leak - - - - - - -Varela, 2005 All patients - - - - - - -

Non Prolonged air leak

- - - - - - -

Prolonged air leak 21 Euro/NR (2003)

- - Medical staff; Total excess pharmacy costs for cohort: €712.43

- Overall Hospital costs (initial surgery + readmissions); Total estimated PAL costs excess for cohort: €39437 [64,701] (Total cost LOS excess + Total excess pharmacy costs for PAL patients, nb costs for whole cohort of 21 cases, not per patient)

Mixed pulmonary resection type populationsAntanavicius, 2005

All patients - - - - - - -No Air Leak Group: Water seal use

- - - - - - -

No Air Leak Group: Suction use

- - - - - - -

Air Leak Group: Water seal use

- - - - - - -

Air Leak Group: Suction use

- - - - - - -

Bardell, 2003 All patients 91 - - - - - -

43



Pneumothorax any time on CXR

37 - - - - - -

No Pneumothorax any time on CXR

54 - - - - - -

Pneumothorax on postoperative CXR

25 - - - - - -

No Pneumothorax on postoperative CXR

66 - - - - - -

Subcutaneous emphysema

41 - - - - - -

No Subcutaneous emphysema

50 - - - - - -

Atelectasis 20 - - - - - -No Atelectasis 71 - - - - - -Reoperation 6 - - - - - -No Reoperation 85 - - - - - -Prolonged air leak 27 - - - - - -No Prolonged air leak

64 - - - - - -

Dulu, 2006 All patients - - - - - - -Patients who acquired ALI and/or ARDS requiring invasive mechanical ventilation and ICU admission

- - - - - - -

Patients who No ALI and/or ARDS requiring mechanical ventilation

- - - - - - -

Patients with ALI/ARDS and ICU stay Alive at Hospital Discharge

- - - - - - -

44



Patients with ALI/ARDS and ICU stay Dead at Hospital Discharge

- - - - - - -

Ghosh, 2004 All patients (lobectomies, pneumonectomies and oesophagectomies

- - - - - - -

All Patients managed in the high dependency unit (HDU)

- - - - - - -

Lung resection patients

- - - - - - -

Esophagectomy patients

- - - - - - -

Ishikawa, 2012 All patients 1129 - - - - - -Patients with Acute kidney injury diagnosed within 72 hours postoperatively

67 - - - - - -

Patients without Acute kidney injury

1062 - - - - - -

Pilling, 2004 ICU admitted patients after pulmonary resection

28 US $/NR (2001)

- - - - Overall Hospital costs (initial surgery + readmissions): $6,975 (3100–186,775) [9,416 (4,185–252,146)] (ICU and hospital stay)

ICU admitted patients after pulmonary resection: Hospital Survivors

15 - - - - Overall Hospital costs (initial surgery + readmissions): $6,975 (3100–56,575) [9,416 (4,185–76,376)] (ICU

45


Preoperative Intraoperative Postoperative Indirect costs Total hospital costs[2013 US$]and hospital stay)

ICU admitted patients after pulmonary resection: Hospital Deaths

13 - - - - Overall Hospital costs (initial surgery + readmissions): $19,375 (3100–186,755) [26,156 (4,185–252,146)] (ICU and hospital stay)

Roselli, 2005 All patients - - - - - - -Postoperative Atrial fibrillation (propensity-matched patients)

91 - - - - - Total hospital costs (initial admission), Cost ratio: 1.8 (direct technical costs of postoperative care were higher for the AF group)

No postoperative Atrial fibrillation (propensity-matched patients)

91 - - - - - -

Atrial fibrillation as a SOLITARY complication (propensity-matched patients)

74 - - - - - Total hospital costs (initial admission), Cost ratio: 1.5 (costs of postoperative care were higher for the group with AF as a sole complication)


75 - - - - - -

Seely, 2010 Pulmonary resection patients with air leak

- - - - - - -

Pulmonary resection patients with atrial fibrillation

- - - - - - -

Pulmonary resection patients with

- - - - - - -

46



PneumothoraxPulmonary resection patients with MI

- - - - - - -

Pulmonary resection patients with Pneumonia

- - - - - - -


47

Table A12: Resource use associated with thoracic surgery


ICU days


Medication use Tests/ Diagnosis

Other

Lobectomy/bilobectomyHandy, Jr, 2011

Uncomplicated (lobectomy)

222 Mean: 6 - - - - - -

Complications or Death (lobectomy)

46 Mean: 12 - - - - - -

Liberman, 2010

Overall study population

778 Mean (SD): 7.8 (15.9)

Median (range): 5.0 (2-373)

- - - - - Time to removal of drains (chest), days, mean (SD): 3.9 (3.9)

Time to removal of drains (chest), days (median, range): 3.0 (0-57)

Prolonged air leak 78 Mean (SD): 14.2 (13.3)

Median (range): 12.0 (6–104)

- Reoperation, No (%) patients re-operated:o wedge

resection: 1 (1.3%)

o Muscle flap: 1 (1.3%)

- - - No. of patients with readmissions, n (%): 1 (1.3%) (for pneumothorax)

Time to removal of drains (chest), days, mean (SD): 11.5 (4.4)

Time to removal of drains (chest), days (median, range): 11.0 (6-27)

Non-pharmacological management:o pleurodesis for PAL:

41 (52.6%)o discharge home with

Heimlich valve: 4 (Total)

o placement of a chest tube: 1(1.3%)

Control (700 consecutive patients)

NR - - - - - - -

Okereke, 2005 All patients 319 - - - - - - -Air leak 82 - - - - - - P value vs comparator, length

of stay > 5 days: P=0.02No air leak 82 - - - - - - -

Seely, 2010 Lobectomy patients with Grade I complications

- Median (range): 5.5 (5 to 11)

- - - - - P value vs comparator (analysis of variance): P<0.0001

48


ICU days



Other

Lobectomy patients with Grade II complications

- Median (range): 8 (3 to 42)

- - - - - -

Lobectomy patients with Grade IIIa complications

- Median (range: 8 (3 to 23)

- - - - - -

Lobectomy patients with Grade IIIb complications

- Median (range): 7.5 (5 to 14),

- - - - - -

Lobectomy patients with Grade IVa complications

- Median (range): 31 (19 to 114 )

- - - - - -

Lobectomy patients with Grade IVb complications

- Median: 43 - - - - - -

Stolz, 2005 All patients 134 - - - - - - -Non Prolonged air leak

121 Mean (SD): 7.9 (1.44)

- - - - - P value vs comparator, length of stay (initial admission): P<0.01

Prolonged air leak 13 Mean (SD): 13.7(3.92)

- - - - - -

Varela, 2005 All patients 238 Mean (SD): 6.3 (3.3)

- - - - - Total stay (initial +readmissions), median (range: 5 (3-34)

Non Prolonged air leak

215 - - - - - - Total stay (initial +readmissions), median (range: 5 (3-34)

P value vs comparator for total stay: P<0.001

Prolonged air leak 23 - - - - - - No. of patients with readmissions, n (%): 3 (13%)

Readmissions, length of stay (days, mean SD): 2 and 14 days (pneumothorax cases), and 49 days (empyema patient)

Total stay (initial +readmissions), median (range: 10 (6-22)

Mixed pulmonary resection type populations

49


ICU days



Other

Antanavicius, 2005

All patients 109 - - - - - - -No Air Leak Group: Water seal use

32 Mean (SD): 5.13 (0.61)

- - - - - P value versus comparator (length of stay, water seal vs suction, no air-leak patients): P<0.04


Time to chest tube conversion to water seal, days, mean (SD): 2.65 (1.09)

Time to removal of chest tube, P value vs comparator (water seal vs suction, no air-leak patients time to drain removal): P=0.007

No Air Leak Group: Suction use

46 Mean (SD): 6.74 (0.5)

- - - - - Time to removal of drains (chest), days, mean (SD): 4.52 (0.4)

Air Leak Group: Water seal use

7 Mean (SD): 6.57 (0.69)

- - - - - P value versus comparator (length of stay, water seal vs suction, air-leak patients): P<0.05


Time to chest tube conversion to water seal, days, mean (SD):

Time to removal of chest tube, P value vs comparator (water seal vs suction, air-leak patients time to drain removal): P=0.001

Treatment; discharged with indwelling chest tubes with Heimlich valve management: 3 (includes suction and water seal groups)

Air Leak Group: 24 Mean (SD): - - - - - Time to removal of drains

50


ICU days



Other

Suction use 8.96 (0.86) (chest), days, mean (SD): 6.35 (0.65)

Time to chest tube conversion to water seal, days, mean (SD): 4.43(2.17)

Time to chest tube conversion to water seal, days, mean (SD): 4.43(2.17)

Treatment; discharged with indwelling chest tubes with Heimlich valve management: 3 (includes suction and water seal groups)

Bardell, 2003 All patients 91 Mean (SD): 6.4

- - - - - -

Pneumothorax any time on CXR

37 Mean (SD): 7.5

- - - - - P value versus comparator (length of stay, water seal vs suction, air-leak patients): P 0.06

No Pneumothorax any time on CXR

54 Mean (SD): 5.8

- - - - - -

Pneumothorax on postoperative CXR

25 Mean (SD): 7.8

- - - - - P value versus comparator (length of stay, water seal vs suction, air-leak patients): P=0.049

No Pneumothorax on postoperative CXR

66 Mean (SD): 5.9

- - - - - -

Subcutaneous emphysema

41 Mean (SD): 7.3


No Subcutaneous emphysema

50 Mean (SD): 5.8

- - - - - -

Atelectasis 20 Mean (SD): 6.9


51


ICU days



Other

No Atelectasis 71 Mean (SD): 6.3

- - - - - -

Reoperation 6 Mean (SD): 16.8


No Reoperation 85 Mean (SD): 5.7

- - - - - -

Prolonged air leak 27 Mean (SD): 9.4


No Prolonged air leak 64 Mean (SD): 5.2

- - - - - -

Dulu, 2006 All patients - - - - - - -

Patients who acquired ALI and/or ARDS requiring invasive mechanical ventilation and ICU admission

50 Median (range): 26.6 (6-93)

Median (range): 10 (2-43)

- - Corticosteroids: 39 (78%)

- -

Patients who No ALI and/or ARDS requiring mechanical ventilation

- - - - - - - -

Patients with ALI/ARDS and ICU stay Alive at Hospital Discharge

30 Median (range): 24.5 (10-58)


- - Corticosteroids: 25 (64%)

P value versus comparator (Pharmacological management administered; for corticosteroid use): 0.31

- -

Patients with ALI/ARDS and ICU stay Dead at Hospital Discharge

20 Median (range): 28.5 (6-93)

Median (range): 15.5 (3-43)

- - Corticosteroids: 14 (36)

- -

Ghosh, 2004 All patients (lobectomies, pneumonectomies and

- - - - - - - -

52


ICU days



Other

oesophagectomies)All Patients managed in the high dependency unit (HDU)

318 Mean (SD): 21.8 hours

- No of patients with additional procedures OR re-exploration, n (%) and reasons: initially monitored in the recovery unit and then re-explored for bleeding: 2

- - - No. of patients with readmissions, n (%): 8.4

No. of patients with ICU visits, n (%): 6.1

Non Pharmacological management administered, No (%) patients given mechanical ventilation or needed more invasive monitoring with inotropes in ITU: 6

Lung resection patients

277 Mean (SD): 7.3

- - - - - -

Esophagectomy patients

50 Mean (SD): 9.1

- - - - - -

Ishikawa, 2012 All patients 1129 Median (range): 8 (IQR 6-11)

- - No (%) patients given:Received Red blood cells: 20 (2) Received fresh frozen plasma: 2 (0.2) Received platelets: 2 (0.2)

Pharmacological management, No (%) patients given: Adjuvant epidural: 701 (62)

- P value vs comparator, length of stay (initial admission): P<0.001

Operating room time, median (IQR): 109 (63)

P value vs comparator (operation duration): P<0.001

Non Pharmacological management, No (%) patients given:o Received

hydroxyethyl starch: 74 (7)

o Mechanical ventilation:47 (4)

o Reintubation: 28 (2)Patients with Acute kidney injury diagnosed within 72 hours postoperatively

67 Median (range): 10 (IQR 7-14)

- - No (%) patients given:Received Red blood cells: 5 (7) Received fresh frozen plasma:0 Received


- Operating room time, median (IQR): 143 (73)




o Reintubation: 8 (12)

53


ICU days



Other

platelets: 1 (2)

Patients without Acute kidney injury

1062 Median (range): 8 (IQR 5-10)

- - No (%) patients given:Received Red blood cells: 15 (1)Received fresh frozen plasma: 2 (0.2) Received platelets: 1 (0.1)


- Operating room time, median (IQR): 107 (62)




o Reintubation: 28 (2)

Pilling, 2004 ICU admitted patients after pulmonary resection

28 Median (range): 21 (5-91)


No of patients with additional procedures OR re-exploration, n (%) and reasons: 7 (25): 4 patients underwent thoracotomy (2 patients for control of haemorrhage, 1 patient for repair of a dehisced diaphragmatic patch, and 1 patient for decortication of a postoperative empyema). 3 patients required laparotomy (for control of upper gastrointestinal haemorrhage in 2 patients, and for repair of strangulated inguinal hernia in 1 patient).

- Pharmacological management, No (%) patients given:o Inotropic support

(either adrenaline, noradrenaline, or high-dose dopamine infusion): 15 (54%)

o Continuous infusion of diuretics and low-dose dopamine for Renal failure: 11 (39%)

o Required intravenous antibiotics for clinically significant methicillin-resistant Staphylococcus aureus (MRSA) infection: 14 (50%)

Length of stay of pts discharged from ICU back to ward, median (range); 3 days (1-35)

P value versus comparator (length of stay): p=0.6

Total stay (initial +readmissions), median (range): 23 days (11-90 days).

Length of stay in high dependency unit prior to ICU admission, median (range): 5 (1-60)

P value versus comparator (length of stay in ICU): p=0.08

Non Pharmacological management, No (%) patients given:o Mechanical

ventilation after ICU admission: 17 (16%)

o Use of bronchoscopy and insertion of minitracheostomy: 2

o Invasively monitored

54


ICU days



Other

without inotropic support: 13 (46%)

ICU admitted patients after pulmonary resection: Hospital Survivors

15 Median (range): 22 (11-91)


- - - - -

ICU admitted patients after pulmonary resection: Hospital Deaths

13 Median (range): 17 (5-91)


- - - - -

Roselli, 2005 All patients - - - - - - - -Postoperative Atrial fibrillation (propensity-matched patients)

91 Median (range): 8 (15th and 85th percentiles 5 and 14 days)

- - - - - P value versus comparator (length of stay): P<0.0001


91 Median (range): 5 (15th and 85th percentiles 4 and 10 days)

- - - - - -

Atrial fibrillation as a SOLITARY complication (propensity-matched patients)

75 Median (range): 7

- - - - - P value versus comparator (length of stay): CL 5-9 days, P < 0.0001 (68% Confidence limits used)


75 Median (range): 5

- - - - - P value versus comparator (length of stay): CL 4-8 days (68% Confidence limits used)

Seely, 2010 Pulmonary resection patients with air leak

- - - - - - - Length of stay in hospital (initial admission), No of patients with prolonged length of stay, n(%): 12 (29)

Length of stay in hospital (readmissions), No. of patients with readmissions, n(%):7

55


ICU days



Other

(17)Pulmonary resection patients with atrial fibrillation

41 - - - - - - Length of stay in hospital (initial admission), No of patients with prolonged length of stay, n(%): 3 (7)

Length of stay in hospital (readmissions), No. of patients with readmissions, n(%): 1(2)

Pulmonary resection patients with Pneumothorax


Length of stay in hospital (readmissions), No. of patients with readmissions, n(%): 0 (0)

Pulmonary resection patients with MI

41 - - - - - - Length of stay in hospital (initial admission), No of patients with prolonged length of stay, n(%):1 (2)

Length of stay in hospital (readmissions), No. of patients with readmissions, n(%): 0 (0)

Pulmonary resection patients with Pneumonia


Length of stay in hospital (readmissions), No. of patients with readmissions, n(%):0 (0)

56

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