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Hospital costs of colorectal cancer surgery for the oldest old: A Dutch population‐based study
Author(s) -
Govaert Johannes A.,
Govaert Marc J.P.M.,
Fiocco Marta,
van Dijk Wouter A.,
Tollenaar Rob A.E.M.,
Wouters Michel W.J.M.
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24428
Subject(s) - medicine , colorectal cancer , cancer , population , emergency medicine , surgery , environmental health
Background Due to increasing healthcare costs, discussions regarding increased hospital costs when operating on high‐risk patients is rising. Therefore, the aim of this study was to analyze if oldest‐old colorectal cancer patients have a greater impact on hospital costs than their younger counterparts. Methods All colorectal cancer procedures performed in 29 Dutch hospitals between 2010 and 2012 and listed in the Dutch Surgical Colorectal Audit were analyzed. Oldest‐old patients (≥85 years) were compared to patients <85 years. Ninety‐day hospital costs were measured uniformly in all hospitals based on time‐driven activity‐based costs. Results Compared to <85‐year‐old patients (n = 9130), the oldest old (n = 783) had longer hospital stays (LOS) (11.3 vs. 13.2, P < 0.001), more severe complications (21.8% vs. 29.0%, P < 0.001), more failure to rescue (13.9% vs. 37.0%, P < 0.001) and higher mortality (3.0% vs. 10.7%, P < 0.001). Deceased oldest‐old patients had significantly less LOS and less LOS ICU. Total hospital costs were 3% lower for oldest‐old patients (€13,168) than for <85‐year‐old patients (€13,644, P < 0.001). In cases of severe complications or death, hospital costs for the oldest old were 25% and 31% lower than those of <85‐year‐old patients (both P < 0.001). Conclusion Although frequently assumed to be more expensive, operating on oldest‐old patients with colorectal cancer does not increase hospital costs compared to younger patients. This was most likely due to faster deterioration or less aggressive treatment of oldest‐old patients when (severe) complications occurred. J. Surg. Oncol. 2016;114:1009–1015 . © 2016 Wiley Periodicals, Inc.