Cost of postoperative complications after general surgery at a major Canadian academic centre.

BACKGROUND: In a fiscally constrained health care environment, the need to reduce unnecessary spending is paramount. Postoperative complications contribute to hospital costs and utilization of health care resources. OBJECTIVE: The purpose of this observational study was to identify the cost associated with complications of common general surgery procedures performed at a major academic hospital in Toronto, Ontario. METHODS: The institutional National Surgical Quality Improvement Program database was used to identify complications in patients who underwent general surgical procedures at our institution from April 2015 to February 2018. A mix of elective and emergent cases was included: bariatric surgery, laparoscopic appendectomy, laparoscopic cholecystectomy, thyroidectomy, right hemicolectomy and ventral incisional hernia repair. The total cost for each visit was calculated by adding all the aggregate costs of inpatient care. Median total costs and the breakdown of cost components were compared in cases with and without complications. RESULTS: A total of 2713 patients were included. Nearly 6% of patients experienced at least one complication, with an incidence ranging from 1.1% after bariatric surgery to 23.8% after right hemicolectomy. The most common type of complication varied by procedure. Median total costs were significantly higher in cases with complications, with a net increase ranging from $2989 CAD (35% increase) after bariatric surgery to $10 459 CAD (161% increase) after ventral incisional hernia repair. CONCLUSION: Postoperative complications after both elective and emergent general surgery procedures add substantially to hospital costs. Quality improvement initiatives targeted at decreasing postoperative complications could significantly reduce costs in addition to improving patient outcomes.

Tumor necrosis factor therapy and the risk of serious infection and malignancy in patients with early rheumatoid arthritis: a meta-analysis of randomized controlled trials.

OBJECTIVE: To conduct a meta-analysis of the rates of serious infection and malignancy in patients with early rheumatoid arthritis (RA) who have started anti-tumor necrosis factor (anti-TNF) therapy and had not received treatment with disease-modifying antirheumatic drugs (DMARDs) or methotrexate (MTX). METHODS: A systematic literature search was conducted through the summer of 2009. All studies included were randomized, double-blind, placebo-controlled trials involving patients with early RA who were started on anti-TNF therapy without prior DMARD/MTX use. Six trials met the inclusion criteria for the meta-analysis, comprising a total of 2,183 patients receiving biologic therapy and 1,236 patients receiving MTX. The data extracted were from published trials. RESULTS: A pooled odds ratio (OR) (determined using Mantel-Haenszel methods, with a continuity correction designed for sparse data) was calculated for serious infections (requiring hospitalization) and malignancies, comparing anti-TNF therapy to MTX control. The pooled OR for serious infections was 1.28 (95% confidence interval [95% CI] 0.82-2.00) and that for malignancies was 1.08 (95% CI 0.50-2.32). There was no significant difference in either the rate of serious infections or the rate of malignancies between the anti-TNF therapy group and the control group. CONCLUSION: Whereas other meta-analyses have shown an increased risk of serious infection and malignancy in patients receiving anti-TNF therapy, the results of the present meta-analysis show that there is not an increased risk when the patients have early disease and have not previously been treated with DMARDs and/or MTX.

Counseling regarding pregnancy--related drug exposures by family physicians in Ontario.

BACKGROUND: Family physicians may play a significant role in providing information to their patients on the effects of medication exposure during pregnancy. Women must receive accurate information, as unrealistic perception of teratogenic risk may lead to inadequate treatment of maternal disease or termination of otherwise wanted pregnancies. OBJECTIVES: To collect data on the current practices of family physicians in providing information regarding pregnancy-related drug exposures, in particular, their confidence in providing counseling and their sources of information. METHODS: A mailed survey was sent to a random sample of family physicians in Ontario. Outcome measures included the proportion of family physicians that feel confident in providing counseling regarding drugs in pregnancy, most common resources, barriers to counseling and preferences for future educational programs. RESULTS: Of the 756 surveys, 400 (53%) were returned, 265 (66%) by practicing physicians caring for women of childbearing age. Most (80.3%) felt confident in providing counseling, though a majority (56%) stated that available sources of information are not adequate. The most commonly consulted source was the Motherisk Program (62%). Lack of evidence-based information was cited as the major barrier. CONCLUSIONS: Although family physicians were confident in providing counseling to pregnant patients with regards to drug use, more than one-half thought that the available sources of information are not adequate. The dissemination of more evidence-based information in this field is needed.