Format

Send to

Choose Destination
J Surg Res. 2017 Jul;215:183-189. doi: 10.1016/j.jss.2017.03.067. Epub 2017 Apr 7.

Financial benefit of a smoking cessation program prior to elective colorectal surgery.

Author information

1
Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington. Electronic address: cgaskill@uw.edu.
2
Department of Surgery, University of Washington, Seattle, Washington; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Department of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah.
4
Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington.
5
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.

Abstract

BACKGROUND:

Cigarette smoking increases the risk of postoperative complications nearly 2-fold. Preoperative smoking cessation programs may reduce complications as well as overall postoperative costs. We aim to create an economic evaluation framework to estimate the potential value of preoperative smoking cessation programs for patients undergoing elective colorectal surgery.

METHODS:

A decision-analytic model from the payer perspective was developed to integrate the costs and incidence of 90-day postoperative complications and readmissions for a cohort of patients undergoing elective colorectal surgery after a smoking cessation program versus usual care. Complication, readmission, and cost data were derived from a cohort of 534 current smokers and recent quitters undergoing elective colorectal resections in Washington State's Surgical Care and Outcomes Assessment Program linked to Washington State's Comprehensive Hospital Abstract Reporting System. Smoking cessation program efficacy was obtained from the literature. Sensitivity analyses were performed to account for uncertainty.

RESULTS:

For a cohort of patients, the base case estimates imply that the total direct medical costs for patients who underwent a preoperative smoking cessation program were on average $304 (95% CI: $40-$571) lower per patient than those under usual care during the first 90 days after surgery. The model was most sensitive to the odds of recent quitters developing complications or requiring readmission, and smoking program efficacy.

CONCLUSIONS:

A preoperative smoking cessation program is predicted to be cost-saving over the global postoperative period if the cost of the intervention is below $304 per patient. This framework allows the value of smoking cessation programs of variable cost and effectiveness to be determined.

KEYWORDS:

Colorectal; Cost; Smoking cessation program; Surgery; Tobacco

PMID:
28688645
PMCID:
PMC5526103
DOI:
10.1016/j.jss.2017.03.067
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center