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
Operating theatre: 3,567.58
Hospital stay:4,950radiological imaging:80Laboratory:472.8
2404.99 11654.97 [21567.48]
Grade B POPF 104 tests and radiological investigations: 179.6
Operating theatre: 3,567.58
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
Operating theatre: 3,567.58
Hospital stay:20,700Intensive care:6500Reoperation:2000Transfusions:280
12,276.25 59492.64 [110090.96]
18
Study Comparison group n Currency/cost year¶
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]
Total parenteral or enteral nutrition:3,700Octreotide:483.3radiological imaging:1,674Laboratory:1,815.20
Fuks, 2009 - - - - - - - -Haddad, 2009 - - - - - - - -Topal, 2007 All patients 109 EUR †/NR
(2005)- - - - 10406 (5570 - 30999)
[16325 (8738-48634)]Patients with post operative pancreatic fistula (POPF)
14 - Operation room: 2264 (1007-6475)
Hospital stay: 4847 (520-7956)Intensive care: 0 (0-3667)Emergency: 0(0-87)Functional measurement: 0 (0-227)Imaging: 142 (0-512)Laboratory: 1164 (707-9712)Medical Staff (unspecified): 2057 (1296-5132)Paramedical personnel: 259 (0-1035)Pharmacy: 3140 (2008-7298)Care logistics: 53 (53-159)
- 15225 (10171-30685) [23886 (15957-48141)]
Patients with complications other than POPF
37 - Operation room: 2199 (1002-5079)
Hospital stay: 3639 (1213-13493)Intensive care: 0 (0-7215)Emergency: 0 (0-499)Functional measurement: 33 (0-821)Imaging: 109 (0-685)Laboratory: 877 (412-5147)Medical Staff (unspecified): 1950 (1301-5750)Paramedical personnel: 194
- 11393 (6716- 30999) [17874 (10536-48634)]
19
Study Comparison group n Currency/cost year¶
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]
(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)]
Patients with grade 4 TOSGS-score of complication
NR - - - - NR
Patients with grade 5 TOSGS-score of complication
2 - - - - 19355 (8026-30685) [30366 (12591-48141)]
Vanounou, 2007§
All patients NR US $/NR (2007)
- - - - NRNo pancreatic fistula or other complication
167 - - - - 18,254 [21,357]
Any grade of fistula NR - - - - NRGrade A pancreatic fistula
26 - - - - 18,235 [21,334]
Grade B pancreatic fistula
28 - - - - 30,581 [35,779]
20
Study Comparison group n Currency/cost year¶
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]
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 $4254 [5274] and still be economically justified. Many of the PLs were manifesting as both a fistula and a sterile collection, or a fistula
21
Study Comparison group n Currency/cost year¶
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]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 $/NR (2008)
- - - - NR‘No relevance’ (patients who either lacked evidence of fistula or demonstrated biochemical evidence alone)
349 - - - - Total, including readmission cost:17556 (IQR 15176–22071) [19312 (IQR 16694-24278)]
Evident fistula 36 - - - - Total, including readmission cost:23542 (IQR 17337–43640) [25896 (IQR 19071-48004)]
Latent Fistula 20 - - - - Total, including readmission cost:31750 (IQR 20907–47743) [34925 (IQR 22998-52517)]
Type I: subacute 6 - - - - Total, including
22
Study Comparison group n Currency/cost year¶
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]
latent pancreatic fistula
readmission cost:22873 (IQR 17508–30248) [25160 (IQR 19259-33273)]
Type II: acute latent pancreatic fistula
8 - - - - Total, including readmission cost:32206 (IQR 19312–102146) [35427 (IQR 21243-112361)]
Type III: critical latent pancreatic fistula
6 - - - - Total, including readmission cost:40517 (IQR 34864–107454) [44569 (IQR 38350-118199)]
Hepatic resectionBreitenstein, 2010
All patients 615 US $/NR (2009)
- - - - 35,028 (IQR 25,572-51,338) †, 51,497 (59,418) ‡ [38531 (IQR 28129-56472) 56647 (65360)]
no complications, or Grade I or II complications
456 - - - - 31,669 (IQR 24,019-40,795) †, 36,931 (27,854) ‡ [34836 (IQR 26421-44875) 40624 (30639)]
grade III or IV complications
159 - - - - 65,228 (IQR 43,130-98,811) †, 94,545 (96,252) ‡ [71751 (IQR 47443-108692) 104000 (105877)]
Score 0-2 (low-risk of postoperative complications)
NR - - - - 32,371 (IQR 24,174-42,830) †, 43,247 (46,991) ‡ [35608 (IQR 26591-47113) 47572 (51690)]
Score 3-5 NR - - - - 35,194 (IQR 26,426-
23
Study Comparison group n Currency/cost year¶
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]
(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%
- -
Grade C pancreatic fistula
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
pancreatic fistula (POPF)Patients with complications other than POPF
37 21 (8-52) † - - - - - -
Patients without complications
58 14 (7-33) † - - - - - -
Patients with grade 1 TOSGS-score of complication
2 15 (15-15) † - - - - - -
Patients with grade 4 TOSGS-score of complication
2 30 (29-31) † - - - - - -
Patients with grade 5 TOSGS-score of complication
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 - - - - - -
Grade C pancreatic fistula
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
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
Study Comparison group
n Hospital stay (days)
ICU days/visits
Re-operation Blood transfusion Medication use Tests/Diagnosis Other
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) † §
(intraoperative)- - -
grade III or IV complications
159 22(IQR 15-31)† 3 (IQR1-8)† - 3 (2-6) † §
(intraoperative)- - -
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†
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]
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
Study Comparison group
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
Study Comparison group
N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/Diagnosis Other
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
Study Comparison group
N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/Diagnosis Other
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 - - - - - - -
Patients without complications
NR - - - - - - -
Table A9: Costs associated with gynaecological surgery
Study Comparison group n Currency/cost year†
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs [2013 US$]
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
134 SSI - - - - £814 [1698] additional cost per patient compared to no SSI
Patients with either Deep incisional or organ/space SSI
34 SSI - - - - £1947 [4062] additional cost per patient compared to no 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 - - - -
†Where the cost year is not reported, the year of data collection (or end thereof for ranges) was used (provided in brackets)
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
Study Comparison group N/n Hospital stay (days)
ICU days Re-operation Blood transfusion Medication use Tests/ Diagnosis Other
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
Study Comparison group N/n Hospital stay (days)
ICU days Re-operation Blood transfusion Medication use Tests/ Diagnosis Other
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
Study Comparison group n Currency/cost year†
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: $39,250 [44,745]
Liberman, 2010 Overall study population
- - - - - - -
Prolonged air leak - - - - - - -Control (700 consecutive patients)
- - - - - - -
Okereke, 2005 All patients - - - - - - -Air leak - - - - - - -No air leak - - - - - - -
Seely, 2010 Lobectomy patients - - - - - - -Lobectomy patients with Grade I complications
- - - - - - -
Lobectomy patients with Grade II complications
- - - - - - -
Lobectomy patients with Grade IIIa complications
- - - - - - -
Lobectomy patients with Grade IIIb complications
- - - - - - -
Lobectomy patients - - - - - - -
42
Study Comparison group n Currency/cost year†
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs[2013 US$]
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
Study Comparison group n Currency/cost year†
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs[2013 US$]
Pneumothorax any time on CXR
37 - - - - - -
No Pneumothorax any time on CXR
54 - - - - - -
Pneumothorax on postoperative CXR
25 - - - - - -
No Pneumothorax on postoperative CXR
66 - - - - - -
Subcutaneous emphysema
41 - - - - - -
No Subcutaneous emphysema
50 - - - - - -
Atelectasis 20 - - - - - -No Atelectasis 71 - - - - - -Reoperation 6 - - - - - -No Reoperation 85 - - - - - -Prolonged air leak 27 - - - - - -No Prolonged air leak
64 - - - - - -
Dulu, 2006 All patients - - - - - - -Patients who acquired ALI and/or ARDS requiring invasive mechanical ventilation and ICU admission
- - - - - - -
Patients who No ALI and/or ARDS requiring mechanical ventilation
- - - - - - -
Patients with ALI/ARDS and ICU stay Alive at Hospital Discharge
- - - - - - -
44
Study Comparison group n Currency/cost year†
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs[2013 US$]
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): $6,975 (3100–56,575) [9,416 (4,185–76,376)] (ICU
45
Study Comparison group n Currency/cost year†
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs[2013 US$]and hospital stay)
ICU admitted patients after pulmonary resection: Hospital Deaths
13 - - - - Overall Hospital costs (initial surgery + readmissions): $19,375 (3100–186,755) [26,156 (4,185–252,146)] (ICU and hospital stay)
Roselli, 2005 All patients - - - - - - -Postoperative Atrial fibrillation (propensity-matched patients)
91 - - - - - Total hospital costs (initial admission), Cost ratio: 1.8 (direct technical costs of postoperative care were higher for the AF group)
No postoperative Atrial fibrillation (propensity-matched patients)
91 - - - - - -
Atrial fibrillation as a SOLITARY complication (propensity-matched patients)
74 - - - - - Total hospital costs (initial admission), Cost ratio: 1.5 (costs of postoperative care were higher for the group with AF as a sole complication)
No postoperative Atrial fibrillation (propensity-matched patients)
75 - - - - - -
Seely, 2010 Pulmonary resection patients with air leak
- - - - - - -
Pulmonary resection patients with atrial fibrillation
- - - - - - -
Pulmonary resection patients with
- - - - - - -
46
Study Comparison group n Currency/cost year†
Preoperative Intraoperative Postoperative Indirect costs Total hospital costs[2013 US$]
PneumothoraxPulmonary resection patients with MI
- - - - - - -
Pulmonary resection patients with Pneumonia
- - - - - - -
†Where the cost year is not reported, the year of data collection (or end thereof for ranges) was used (provided in brackets)
47
Table A12: Resource use associated with thoracic surgery
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
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
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
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
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
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 removal of drains (chest), days, mean (SD): 3.19 (0.24)
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 removal of drains (chest), days, mean (SD): 5.0 (0.49)
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
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
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
- - - - - P value versus comparator (length of stay, water seal vs suction, air-leak patients): P=0.08
No Subcutaneous emphysema
50 Mean (SD): 5.8
- - - - - -
Atelectasis 20 Mean (SD): 6.9
- - - - - P value versus comparator (length of stay, water seal vs suction, air-leak patients): P=0.66
51
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
Other
No Atelectasis 71 Mean (SD): 6.3
- - - - - -
Reoperation 6 Mean (SD): 16.8
- - - - - P value versus comparator (length of stay, water seal vs suction, air-leak patients): P<0.001
No Reoperation 85 Mean (SD): 5.7
- - - - - -
Prolonged air leak 27 Mean (SD): 9.4
- - - - - P value versus comparator (length of stay, water seal vs suction, air-leak patients): P<0.001
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)
Median (range): 9 (2-34)
- - 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
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
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
Pharmacological management, No (%) patients given: Adjuvant epidural: 50 (75)
- Operating room time, median (IQR): 143 (73)
Non Pharmacological management, No (%) patients given:o Received
hydroxyethyl starch: 13 (19)
o Mechanical ventilation:10 (15)
o Reintubation: 8 (12)
53
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
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)
Pharmacological management, No (%) patients given: Adjuvant epidural: 651 (61)
- Operating room time, median (IQR): 107 (62)
Non Pharmacological management, No (%) patients given:o Received
hydroxyethyl starch: 74 (7)
o Mechanical ventilation:47 (4)
o Reintubation: 28 (2)
Pilling, 2004 ICU admitted patients after pulmonary resection
28 Median (range): 21 (5-91)
Median (range): 3 (1-80)
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
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
Other
without inotropic support: 13 (46%)
ICU admitted patients after pulmonary resection: Hospital Survivors
15 Median (range): 22 (11-91)
Median (range): 3 (1-35)
- - - - -
ICU admitted patients after pulmonary resection: Hospital Deaths
13 Median (range): 17 (5-91)
Median (range): 9 (1-80)
- - - - -
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
No postoperative Atrial fibrillation (propensity-matched patients)
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)
No postoperative Atrial fibrillation (propensity-matched patients)
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
Study Comparison group N/n Hospital stay (days)
ICU days
Re-operation Blood transfusion
Medication use Tests/ Diagnosis
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
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 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
41 - - - - - - Length of stay in hospital (initial admission), No of patients with prolonged length of stay, n(%): 2 (5)
Length of stay in hospital (readmissions), No. of patients with readmissions, n(%):0 (0)
56
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