Effect of Disease Complications on Hospital Costs

Background: To test the hypothesis that complications increase the use of resources in managing patients in hospitals, we examined the costs of managing patients with the same disease with and without complications. Methods: We used a database developed by the University HealthSystems Consortium that contains the costs of managing more than 1 million patients in 60 University hospitals. We created a simplified database of the costs of 457 445 patients in 111-paired diagnosis-related groups (DRGs) that were classified as either having or not having complications and/or comorbidities. Costs were calculated from the ratio of costs to charges within the individual hospitals. Results: The median costs of managing patients with complications were higher than those for managing patients without complications, confirming the appropriateness of the dual classification. Notably, these extra costs were largely incurred through increased length of stay. Of note, the cost per day for DRGs with complications and/or comorbidities was most often less than that for the corresponding uncomplicated conditions. Although accommodation costs generally were the largest single component of total costs for both complicated and uncomplicated conditions, in only 31 DRGs (15 with complications, 16 without) did they account for more than one-half the total costs. Laboratory and drug costs were higher for complicated conditions, but as a proportion of total costs were comparable for complicated and uncomplicated conditions. Conclusions: Complications in patients are associated with increased hospital costs, although the costs per day of hospitalization are often less than in patients without such complications.