Supplemental Digital Content
Supplemental Digital Content 1: Table of Current Procedural Terminology (CPT) codes for colectomy
procedures included in study
Supplemental Digital Content 2: Risk-adjusted cost ratios derived from a hierarchical multivariable
generalized linear regression model for cost to Medicare among patients undergoing colectomy (n=
14,745 patients)
Supplemental Digital Content 1: Current Procedural Terminology (CPT) codes for colectomy
procedures included in study
Current
Procedural
Code Description
Terminology
code
44140
Colectomy, partial; with anastomosis
44141
Colectomy, partial; with skin level cecostomy or colostomy
44143
Colectomy, partial; with end colostomy and distal closure of segment
(Hartmann type procedure)
44144
Colectomy, partial; with resection, with colostomy or ileostomy and creation
of mucous fistula
44145
Colectomy, partial; with coloproctostomy (low pelvic anastomosis)
44146
Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with
colostomy
44147
Colectomy, partial; abdominal and transanal approach
44150
Colectomy, total, abdominal, without proctectomy; with ileostomy or
ileoproctostomy
44151
Colectomy, total, abdominal, without proctectomy; with continent ileostomy
44160
Colectomy, partial, with removal of terminal ileum with ileocolostomy
44204
Laparoscopy, surgical; colectomy, partial, with anastomosis
44205
Laparoscopy, surgical; colectomy, partial with removal of terminal ileum with
ileocolostomy
44206
Laparoscopy, surgical; colectomy, partial, with anastomosis, with end
colostomy and closure of distal segment (Hartmann type procedure)
44207
Laparoscopy, surgical; colectomy, partial, with anastomosis, with
coloproctostomy (low pelvic anastomosis
44208
Laparoscopy, surgical; colectomy, partial, with anastomosis, with
coloproctostomy (low pelvic anastomosis) with colostomy
44210
Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy,
with ileostomy or ileoproctostomy
Supplemental Digital Content 2: Risk-adjusted cost ratios derived from a hierarchical
multivariable generalized linear regression model for cost to Medicare among patients
undergoing colectomy (n= 14,745 patients)
Model including only
preoperative risk factors
for risk adjustment
Model including
preoperative risk factors
and postoperative
complications* for risk
adjustment
Risk-adjusted p-value
cost ratio
Risk-adjusted
cost ratio
p-value
Preoperative risk factors
Laparoscopic (vs. open)
0.92
<0.001
0.93
<0.001
Diagnosis (vs. benign neoplasm):
Diverticulitis
Fistula
Hemorrhage
Infectious colitis
Malignancy
Crohn disease/Ulcerative colitis
Obstruction/perforation
Other
Vascular insufficiency
1.15
1.18
1.37
1.20
1.11
1.30
1.23
1.17
1.28
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
1.15
1.15
1.27
1.18
1.09
1.22
1.18
1.15
1.21
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
Age category (vs. 65-74):
75_84
>84
1.03
1.04
<0.001
0.001
1.02
1.05
0.001
<0.001
1.06
<0.001
1.03
<0.001
1.16
0.99
0.93
<0.001
0.497
0.174
1.09
0.99
0.97
<0.001
0.749
0.449
1.10
1.30
<0.001
<0.001
1.08
1.18
<0.001
<0.001
1.18
1.29
1.04
1.04
<0.001
<0.001
0.002
0.043
1.10
1.16
1.02
1.03
<0.001
<0.001
0.034
0.148
Male (vs. female)
Admission source (vs. Home):
Acute care facility
Chronic care facility
Other
ASA category (vs. I and II):
III
IV and V
Functional status (vs. independent):
Partially dependent
Fully dependent
Smoker
>2 drinks/day alcohol
Body mass index category (kg/m2)
Underweight (<18.5)
Normal (18.5-24.9)
Overweight (25-29.9)
Obese I (30-34.9)
Obese II (35-39.9)
Obese III (>39.9)
Diabetes (vs. none):
Oral medication
Insulin dependent
Dyspnea (vs. none):
Moderate exertion
At rest
Ventilator dependent
COPD
Recent myocardial infarction
Congestive heart failure
Hypertension requiring medication
Renal failure
Ascites
Disseminated cancer
Chemotherapy
Radiotherapy
>10% Weight loss in last 6 months
Steroid use
Bleeding disorder
Sepsis (vs. none):
Systemic inflammatory response
Sepsis
Septic shock
Wound class (vs. II)
III
IV
Emergency case
30-day postoperative complications
Superficial surgical site infection
Deep surgical site infection
Organ-space surgical site infection
Dehiscence
Pneumonia
Respiratory failure
Pulmonary embolism
Deep vein thrombosis
Renal failure (vs. none):
Acute renal failure
Progressive renal failure
Urinary tract infection
0.98
Ref
1.00
0.98
1.01
1.12
0.445
--0.998
0.131
0.741
<0.001
0.99
Ref
0.99
0.98
0.98
1.05
0.553
--0.072
0.060
0.195
0.012
1.01
1.09
0.376
<0.001
1.01
1.07
0.423
<0.001
1.03
1.08
1.42
1.08
1.09
1.13
1.03
1.16
1.03
1.05
0.94
0.89
1.08
1.03
1.09
0.018
0.001
<0.001
<0.001
0.007
<0.001
0.001
<0.001
0.190
0.004
0.043
<0.001
<0.001
0.133
<0.001
1.01
1.01
1.37
1.02
1.07
1.12
1.01
1.16
1.05
1.05
0.98
0.92
1.05
1.01
1.06
0.135
0.445
<0.001
0.065
0.008
<0.001
0.115
<0.001
0.008
<0.001
0.430
<0.001
<0.001
0.515
<0.001
1.16
1.21
1.13
<0.001
<0.001
<0.001
1.06
1.10
1.03
<0.001
<0.001
0.135
1.08
1.18
1.08
<0.001
<0.001
<0.001
1.04
1.11
1.04
0.001
<0.001
<0.001
1.04
1.17
1.36
1.12
1.30
1.59
1.21
1.19
0.011
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
1.24
1.14
1.10
<0.001
<0.001
<0.001
1.17
<0.001
Stroke
1.00
0.986
Cardiac arrest requiring CPR
1.27
<0.001
Myocardial infarction
1.10
0.001
Bleeding requiring transfusion
Sepsis (vs. none)
Sepsis
1.21
<0.001
Septic shock
1.17
<0.001
1.28
<0.001
Unplanned return to operating room
0.79
<0.001
Mortality
*Postoperative complications occurring within 30 days of surgery and prior to discharge
from the primary hospitalization.
Preoperative clinical characteristics and postoperative complications identified from
ACS-NSQIP for patients who underwent colectomy procedures between the years 20052008. Costs were derived from Medicare inpatient claims data as described in the text.
ASA, American Society of Anesthesiology; COPD, chronic obstructive pulmonary
disease; CPR, Cardiopulmonary resuscitation.
Intercept for first model: $13,015.07 p<0.001.
Intercept for second model $13,002.99 p<0.001