Postoperative complications and hospital costs following elective and emergency colon cancer surgery: a Clavien-Dindo grade-specific cost analysis

PURPOSE: Postoperative complications are drivers of healthcare costs following colon cancer surgery. We compared hospital costs between elective and emergency colon cancer resections according to complication severity. METHODS: This retrospective cohort study included 520 patients undergoing colon cancer resection, of whom 431 underwent elective and 89 emergency surgery. Postoperative complications were graded according to the Clavien-Dindo classification. Hospital costs were analysed using a micro-costing approach. Adjusted costs were estimated using generalized linear models with gamma distribution and log link, adjusting for tumour stage, ASA classification, age and sex, with surgical technique in elective surgery. RESULTS: CD II-V occurred in 35% of elective and 56% of emergency patients. Emergency patients had higher ASA class, more advanced tumour stage and lower BMI (p < 0.05). Among patients with no or minor complications (CD 0-I), median costs were €9809 following elective surgery and €12,079 following emergency surgery. Among patients with complications, costs were higher in emergency versus elective surgery (€19,655 vs. €14,820; p = 0.004). Adjusted excess costs increased from CD 0-I to CD IV, whereas CD V did not follow this pattern. In adjusted analyses, complication severity remained associated with increased costs, with cost ratios of 3.21 in elective and 4.86 in emergency surgery for grade IV vs no or minor complications; however, the emergency estimate was based on six patients with CD IV complications and should be interpreted cautiously. CONCLUSIONS: Complication severity was independently associated with substantial cost increases after colon resection. Observed costs were generally higher and more variable following emergency surgery.