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- Title
A reduction in hospital length of stay reduces costs for colorectal surgery: an economic evaluation of the National Surgical Quality Improvement Program in Singapore.
- Authors
Tan, Emile John Kwong Wei; Chen, Hui Lionel Raphael; Chok, Aik Yong; Tan, Ivan En-Howe; Zhao, Yun; Lee, Rachel Shiyi; Ang, Kwok Ann; Au, Marianne Kit Har; Ong, Hock Soo; Ho, Henry Sun Sien; Poopalalingam, Ruban; Tan, Hiang Khoon; Kwek, Kenneth Yung Chiang
- Abstract
Purpose: In 2017, the National Surgical Quality Improvement Program (NSQIP) was introduced in the Department of Colorectal Surgery at Singapore General Hospital as a pilot quality improvement initiative. This study aimed to examine the cost-effectiveness of NSQIP by evaluating its effects on surgical outcomes, length of stay (LOS), and costs. Methods: We retrospectively reviewed patients undergoing colorectal surgery (2017–2020). Patients were divided into two cohorts: pre-NSQIP (2017–2018) and post-NSQIP (2019–2020). Outcomes evaluated were 30-day postoperative complications, LOS, and costs. Total cost-savings from NSQIP intervention's impact on LOS were estimated using a decision model with a one-way sensitivity analysis. Multivariate logistic regression was performed to identify factors for prolonged LOS. Results: 1905 patients underwent colorectal surgery, with 996 in the pre-NSQIP cohort and 909 in the post-NSQIP cohort. A significant reduction in overall postoperative complications of 4.7% was observed in the post-NSQIP cohort (36.5% vs. 31.8%, p = 0.029). Patients in the post-NSQIP cohort had a shorter median LOS (8.0 vs. 6.0 days, p < 0.001). The implementation of NSQIP resulted in an 8.5% decrease in prolonged LOS > 6 days (p < 0.001), saving S$0.31 million on LOS. Total costs per case were reduced by 20.8% following NSQIP (S$39,539.05 vs. S$31,311.93, p < 0.001). Conclusion: Implementing NSQIP has significantly reduced overall postoperative complications, LOS, and costs and achieved cost savings following colorectal surgery.
- Subjects
PROCTOLOGY; LENGTH of stay in hospitals; SURGERY; SURGICAL complications; COST
- Publication
International Journal of Colorectal Disease, 2023, Vol 38, Issue 1, p1
- ISSN
0179-1958
- Publication type
Article
- DOI
10.1007/s00384-023-04551-1