Smoking Status and Health Care Costs in the Perioperative Period: A Population-Based Study | Lifestyle Behaviors | JAMA Surgery | JAMA Network
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1.
Centers for Disease Control and Prevention (CDC).  Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.  MMWR Morb Mortal Wkly Rep. 2008;57(45):1226-1228.PubMedGoogle Scholar
2.
Barendregt  JJ, Bonneux  L, van der Maas  PJ.  The health care costs of smoking.  N Engl J Med. 1997;337(15):1052-1057.PubMedGoogle ScholarCrossref
3.
Warner  KE, Hodgson  TA, Carroll  CE.  Medical costs of smoking in the United States: estimates, their validity, and their implications.  Tob Control. 1999;8(3):290-300.PubMedGoogle ScholarCrossref
4.
Fishman  PA, Khan  ZM, Thompson  EE, Curry  SJ.  Health care costs among smokers, former smokers, and never smokers in an HMO.  Health Serv Res. 2003;38(2):733-749.PubMedGoogle ScholarCrossref
5.
Wagner  EH, Curry  SJ, Grothaus  L, Saunders  KW, McBride  CM.  The impact of smoking and quitting on health care use.  Arch Intern Med. 1995;155(16):1789-1795.PubMedGoogle ScholarCrossref
6.
Moriarty  JP, Branda  ME, Olsen  KD,  et al.  The effects of incremental costs of smoking and obesity on health care costs among adults: a 7-year longitudinal study.  J Occup Environ Med. 2012;54(3):286-291.PubMedGoogle ScholarCrossref
7.
Warner  DO.  Perioperative abstinence from cigarettes: physiologic and clinical consequences.  Anesthesiology. 2006;104(2):356-367.PubMedGoogle ScholarCrossref
8.
Singh  JA, Houston  TK, Ponce  BA,  et al.  Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans.  Arthritis Care Res (Hoboken). 2011;63(10):1365-1374.PubMedGoogle ScholarCrossref
9.
Neumayer  L, Hosokawa  P, Itani  K, El-Tamer  M, Henderson  WG, Khuri  SF.  Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study.  J Am Coll Surg. 2007;204(6):1178-1187.PubMedGoogle ScholarCrossref
10.
Kamath  AS, Vaughan Sarrazin  M, Vander Weg  MW, Cai  X, Cullen  J, Katz  DA.  Hospital costs associated with smoking in veterans undergoing general surgery.  J Am Coll Surg.2012;214(6):901-908. PubMedGoogle ScholarCrossref
11.
Zarling  KK, Burke  MV, Gaines  KA, Gauvin  TR.  Registered nurse initiation of a tobacco intervention protocol: leading quality care.  J Cardiovasc Nurs. 2008;23(5):443-448.PubMedGoogle ScholarCrossref
12.
Lipscomb  J, Ancukiewicz  M, Parmigiani  G, Hasselblad  V, Samsa  G, Matchar  DB.  Predicting the cost of illness: a comparison of alternative models applied to stroke.  Med Decis Making. 1998;18(2)(suppl):S39-S56.PubMedGoogle ScholarCrossref
13.
St Sauver  JL, Grossardt  BR, Yawn  BP, Melton  LJ  III, Rocca  WA.  Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester epidemiology project.  Am J Epidemiol. 2011;173(9):1059-1068.PubMedGoogle ScholarCrossref
14.
St Sauver  JL, Grossardt  BR, Yawn  BP,  et al.  Data resource profile: the Rochester Epidemiology Project (REP) medical records-linkage system.  Int J Epidemiol. 2012;41(6):1614-1624.PubMedGoogle ScholarCrossref
15.
Rosenbaum  PR, Rubin  DB.  The central role of the propensity score in observational studies for causal effects.  Biometrika. 1983;70(1):41-55.Google ScholarCrossref
16.
Healthcare Cost and Utilization Project (HCUP). Clinical Classifications Software (CCS) for ICD-90CM. www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed August 7, 2012.
17.
Healthcare Cost and Utilization Project (HCUP). Overview of The Nationwide Inpatient Sample. http://hcup-us.ahrq.gov/nisoverview.jsp. Accessed August 7, 2012.
18.
Leuven E, Sianesi B. PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. 2003. Revised July 19, 2012. http://ideas.repec.org/c/boc/bocode/s432001.html. Accessed November 19, 2013.
19.
Dehejia  RH, Wahba  S.  Matching Methods for Estimating Causal Effects in Non-experimental Studies. Cambridge, MA: National Bureau of Economic Research; 1998.
20.
Dehejia  RH, Wahba  S.  Propensity score-matching for nonexperimental causal studies.  Rev Econ Stat. 2002;84(1):151-161.Google ScholarCrossref
21.
Austin  PC.  A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003.  Stat Med. 2008;27(12):2037-2049.PubMedGoogle ScholarCrossref
22.
Manning  WG, Mullahy  J.  Estimating log models: to transform or not to transform?  J Health Econ. 2001;20(4):461-494.PubMedGoogle ScholarCrossref
23.
Pregibon  D.  Goodness of link tests for generalized linear models.  Appl Stat. 1980;29(1):15-24.Google ScholarCrossref
24.
Duan  N, Manning  WG, Morris  C, Newhouse  JP.  A comparison of alternative models for the demand for medical care.  J Bus Econ Stat. 1983;1:115-126.Google Scholar
25.
Rubin  DB.  The use of matched sampling and regression adjustment to remove bias in observational studies.  Biometrics. 1973;29:185-203.Google ScholarCrossref
26.
Rubin  DB, Thomas  N.  Combining propensity score matching with additional adjustments for prognostic covariates.  J Am Stat Assoc. 2000;95(450).573-585.Google ScholarCrossref
27.
Basu  A, Rathouz  PJ.  Estimating marginal and incremental effects on health outcomes using flexible link and variance function models.  Biostatistics. 2005;6(1):93-109.PubMedGoogle ScholarCrossref
28.
Polsky  D, Glick  HA, Willke  R, Schulman  K.  Confidence intervals for cost-effectiveness ratios: a comparison of four methods.  Health Econ. 1997;6(3):243-252.PubMedGoogle ScholarCrossref
29.
Barber  JA, Thompson  SG.  Analysis and interpretation of cost data in randomised controlled trials: review of published studies.  BMJ. 1998;317(7167):1195-1200.PubMedGoogle ScholarCrossref
30.
Centers for Medicare & Medicaid Services. Berenson-Eggers Type of Service (BETOS). http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/BETOS.html. Accessed November 19, 2013.
31.
Warner  DO, Patten  CA, Ames  SC, Offord  K, Schroeder  D.  Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery.  Anesthesiology. 2004;100(5):1125-1137.PubMedGoogle ScholarCrossref
32.
Møller  AM, Villebro  N, Pedersen  T, Tønnesen  H.  Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial.  Lancet. 2002;359(9301):114-117.PubMedGoogle ScholarCrossref
33.
Theadom  A, Cropley  M.  Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: a systematic review.  Tob Control. 2006;15(5):352-358.PubMedGoogle ScholarCrossref
34.
Thomsen  T, Tønnesen  H, Møller  AM.  Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation.  Br J Surg. 2009;96(5):451-461.PubMedGoogle ScholarCrossref
35.
Møller  AM, Kjellberg  J, Pedersen  T.  Health economic analysis of smoking cessation prior to surgery—based on a randomised trial [in Danish].  Ugeskr Laeger. 2006;168(10):1026-1030.PubMedGoogle Scholar
36.
Warner  DO.  Preoperative smoking cessation: how long is long enough?  Anesthesiology. 2005;102(5):883-884.PubMedGoogle ScholarCrossref
37.
Nåsell  H, Adami  J, Samnegård  E, Tønnesen  H, Ponzer  S.  Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial.  J Bone Joint Surg Am. 2010;92(6):1335-1342.PubMedGoogle ScholarCrossref
38.
Russo  A, Elixhauser  A, Steiner  C, Wier  L.  Hospital-Based Ambulatory Surgery, 2007: Statistical Brief #86. Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Statistical Briefs; 2007.
39.
Tzong  KY, Han  S, Roh  A, Ing  C.  Epidemiology of pediatric surgical admissions in US children: data from the HCUP kids inpatient database.  J Neurosurg Anesthesiol. 2012;24(4):391-395.PubMedGoogle ScholarCrossref
40.
Centers for Disease Control and Prevention (CDC).  Current cigarette smoking among adults—United States, 2011.  MMWR Morb Mortal Wkly Rep. 2012;61(44):889-894.PubMedGoogle Scholar
41.
Warner  DO.  Surgery as a teachable moment: lost opportunities to improve public health.  Arch Surg. 2009;144(12):1106-1107.PubMedGoogle ScholarCrossref
Original Investigation
March 2014

Smoking Status and Health Care Costs in the Perioperative Period: A Population-Based Study

Author Affiliations
  • 1Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
JAMA Surg. 2014;149(3):259-266. doi:10.1001/jamasurg.2013.5009
Abstract

Importance  Cigarette smoking adds an estimated $100 billion in annual incremental direct health care costs nationwide. Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear.

Objective  To test the hypothesis that current and former smoking at the time of admission for inpatient surgery, compared with never smoking, are independently associated with higher incremental health care costs for the surgical episode and the first year after hospital discharge.

Design, Setting, and Participants  This population-based, propensity-matched cohort study, with cohort membership based on smoking status (current smokers, former smokers, and never smokers) was performed at Mayo Clinic in Rochester (a tertiary care center) and included patients at least 18 years old who lived in Olmsted County, Minnesota, for at least 1 year before and after the index surgery.

Exposure  Undergoing an inpatient surgical procedure at Mayo Clinic hospitals between April 1, 2008, and December 31, 2009.

Main Outcomes and Measures  Total costs during the index surgical episode and 1 year after hospital discharge, with the latter standardized as costs per month. Costs were measured using the Olmsted County Healthcare Expenditure and Utilization Database, a claims-based database including information on medical resource use, associated charges, and estimated economic costs for patients receiving care at the 2 medical groups (Mayo Clinic and Olmsted Medical Center) that provide most medical services within Olmsted County, Minnesota.

Results  Propensity matching resulted in 678 matched pairs in the current vs never smoker grouping and 945 pairs in the former vs never smoker grouping. Compared with never smokers, adjusted costs for the index hospitalization did not differ significantly for current or former smokers. However, the adjusted costs in the year after hospitalization were significantly higher for current and former smokers based on regression analysis (predicted monthly difference of $400 [95% CI, $131-$669] and $273 [95% CI, $56-$490] for current and former smokers, respectively).

Conclusions and Relevance  Compared with never smokers, health care costs during the first year after hospital discharge for an inpatient surgical procedure are higher in both former and current smokers, although the cost of the index hospitalization is not affected by smoking status.

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