Incremental cost of complications in colectomy: A warranty guided approach to surgical quality improvement

Background We assessed the warranty cost for colectomy at a single institution, as defined by the additional cost of treating complications distributed across all patients treated. Methods All segmental colectomies from July 8 to June 12 were reviewed for 0, 1, 2, and ≥3 complications. Warranty cost is defined as follows: ([mean additional cost of the case with complication(s) - mean base case cost] × number of episodes)/total population. Results Thousand four hundred twenty-two colectomies were analyzed. The lowest cost case was a laparoscopic resection with 0 complications ($7,739 ± 4,150). Warranty costs were less for laparoscopic versus open colectomy (0 - $0, 1 - $128, 2 - $66, ≥3 - $248 vs 0 - $1,036, 1 - $501, 2 - $520, ≥3 - $1,971). This was true for costs associated with readmission ($303 vs $1,519). Emergency status and elderly status also impacted warranty costs. Conclusions The data demonstrate that warranty costs were highest with open colectomy, emergency cases, and the elderly. These data can be used to measure both quality and cost impact of mitigation strategies.