Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures

BACKGROUND: Complications increase the costs of care of surgical patients. We studied the Premier database to determine the incidence and direct medical costs related to pulmonary complications and compared it to cardiac complications in the same cohort. METHODS: We identified 45,969 discharges in patients undergoing major bowel procedures. Postoperative pulmonary and cardiac complications were identified through the use of International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes and through the use of daily resource use data. Pulmonary complications included pneumonia, tracheobronchitis, pleural effusion, pulmonary failure, and mechanical ventilation more than 48 h after surgery. Cardiac complications included ventricular fibrillation, acute myocardial infarction, cardiogenic shock, cardiopulmonary arrest, transient ischemia, premature ventricular contraction, and acute congestive heart failure. RESULTS: Postoperative pulmonary complications (PPC) or postoperative cardiac complications (PCC) were present in 22% of cases; PPC alone was most common (19.0%), followed by PPC and PCC (1.8%) and PCC alone (1.2%). The incremental cost of PPC is large ($25,498). In comparison, PCC alone only added $7,307 to the total cost. CONCLUSIONS: The current study demonstrates that postoperative pulmonary complications represent a significant source of morbidity and incremental cost after major small intestinal and colon surgery and have greater incidence and costs than cardiac complications alone. Therefore, strategies to reduce the incidence of these complications should be targeted as means of improving health and bending the cost curve in health care.