Post-surgical acute care utilization and cost of care among cancer survivors with an ostomy: Findings from three large hospital systems in the United States

Abstract

Purpose: To describe patterns of 6-month total cost of care and acute care utilization among cancer survivors who received ostomy surgeries in 3 large hospital systems in the United States between 2018 and 2022 and to identify reasons for acute care utilization.

Methods: A retrospective cohort study using electronic medical records and the corresponding hospital revenue data obtained from 3 geographically diverse hospital systems in the United States was performed. 6-month all-cause post-surgical encounters subsequent to respective ostomy surgery dates were included. Clinical reasons for acute care utilization were captured and examined via available diagnosis codes.

Results: Mean six-month total cost of care per patient varied greatly by hospital and by payer type, ranging between $18,000 and $80,000. Inpatient care was the largest driver of these cost, accounting for 70 % of the total cost of care. In the sample, 56 % of the patients experienced one or more post-surgical inpatient admissions over a six-month period. Moreover, 26 % of the acute care events were associated with primary or secondary diagnosis codes potentially attributable to post-surgical ostomy-related complications, accounting for approximately 18 % of the total cost. Patients who received urostomy and/or had metastatic cancer had higher rates of acute care utilization, although statistical significances were not achieved.

Conclusion: The results are indicative of significant financial burdens as well as morbidities associated with post-surgical ostomy care that are common across hospital systems. Some of these cost burdens are potentially avoidable with improved ostomy follow-up care.

Keywords: Cost; Insurance; Ostomy; Reimbursement; Surgery; Survivorship; Utilization.