Wide variation in Medicare payments to treat post-surgical complications


Post-operative complications are always costly. But depending on the hospital, they can cost much more than anticipated.

That's the conclusion of researchers at the University of Michigan School of Medicine and Brigham and Women's Hospital in Boston. The research team examined more than 576,000 Medicare patients who suffered post-surgical complications for abdominal aortic aneurysm repair, oncology-related colectomies, pulmonary resection and total hip replacements. Complication rates ranged from 4.9 percent for the hip replacements to 25.1 percent for the colectomies.

Prior research has suggested that higher-volume facilities tend to have better outcomes and associated lower costs.

The cost of delivering care for the post-surgery complications was anywhere from two to three times higher at more expensive hospitals than at lower-cost facilities, with quality of care often suffering in comparison, according to their study, which was published in JAMA Surgery.

The study concluded that at the higher-cost hospitals, payments for what it termed “cost of rescue” ranged from:

  • $23,261 to $60,456 for aortic aneurysm cases
  • $22,853 and $56,787 for colectomies
  • $21,325 to $63,117 for pulmonary resections
  • $19,028 to $41,354 for hip replacement cases

Price variation is nothing new for hospitals; it is commonplace around the country. But research has suggested that price variation tends to lead to higher overall costs for patients.

Mortality rates ranged from 3.4 percent for the hip replacement cases to 18 percent for the pulmonary resections. Other studies have suggested that mortality rates are improved when a patient is readmitted to the same hospital following post-surgical complications.

“Compared with lowest cost-of-rescue hospitals, highest cost-of-rescue hospitals had higher risk-adjusted rates of serious complications with similar rates of failure to rescue and overall 30-day mortality,” the study concluded.

The study tends to contradict the conclusions of other researchers, who have suggested that reducing surgical complications would improve the bottom lines of hospitals.