Outcome and resource utilization in gastroenterological surgery

Background: A small minority of patients undergoing gastroenterological sur gery are at high risk for postoperative complications, which may lead to pr olonged hospital stay, disproportionate use of resources and increased mort ality. The nature and frequency of, and predictive factors for, postoperati ve complications were studied and the impact of complications on resource u tilization was assessed. Methods: A prospective observational study was undertaken of 503 patients u ndergoing gastroenterological surgery in a tertiary care centre. The incide nce of cardiorespiratory, infective and surgical complications was assessed . The need for reoperation, intensive care and length of hospital stay, rea dmission, death at 6 months and costs were evaluated. Results: Some 235 patients (47 per cent) had at least one complication, mos t commonly delayed oral intake (n = 70). Complications were associated with cardiovascular disease, prolonged operation, high Physiological and Operat ive Severity Score for the enUmeration of Mortality and morbidity, and incr eased number of Shoemaker's criteria. The length of hospital stay of patien ts with complications was longer than that of those without complications ( 11 versus 6 days). Morbidity resulted in a twofold increase in median costs . Conclusion: High-risk patients could be identified by simple clinical crite ria, although the commonly used risk criteria were not very sensitive. A re duction in postoperative complication rates would result in marked cost sav ings.