# Financial Burden of Postoperative Adverse Events Following Lobectomy: Cost Analysis From 10 High-Volume Canadian Hospitals

## TL;DR

This study finds that complications after lung cancer surgery cost Canadian hospitals millions annually, with air leaks being the biggest expense.

## Contribution

The paper quantifies the financial impact of postoperative complications after lobectomy in Canadian hospitals, identifying prolonged air leak as the main cost driver.

## Key findings

- Prolonged air leak accounts for 51% of adverse event occurrences and 17% annual incidence, contributing over half of total costs.
- Postoperative adverse events add over $7.31 million in costs per hospital annually, extrapolating to $48 million nationally.

## Abstract

Lobectomy remains a cornerstone of curative intent treatment for lung cancer; however, postoperative adverse events (AEs) remain common, harmful, and costly. To support value-based quality improvement (QI) programmes, we sought to estimate the in-hospital costs of AEs following lobectomy and identify which complications are the primary cost drivers.

Lobectomy data from 10 Canadian hospitals were included (2017-2022). Annual lobectomy volume, demographics, length of stay (LOS), incidence, and severity of AEs were obtained from a prospectively collected national database. Using literature-derived index hospitalization costs of AEs, supported by Canadian Institution of Health Information database, estimates of annual AE costs were obtained (2025 CDN$).

Mean annual lobectomy volume 1150 (SD = 165): 44% male, aged 67 years (SD = 10.9), median LOS of 4 days (interquartile range [IQR] = 4), with minimally invasive surgery performed in 86%. Prolonged air leak (PAL) contributed 51% of total AEs occurrences, followed by atrial arrhythmia (13%), pneumonia (7.9%), reoperation (5.2%), atelectasis (3.9%), delirium (3.4%), transfusion (2.8%), respiratory failure (2.8%), empyema (2.2%), acute kidney injury (1.7%), and pulmonary embolism (1.2%), adding over $7.31 million (M) to hospital-level costs. PAL, mean annual incidence of 17%, was the strongest driver of costs. Extrapolated nationally, lobectomy-related AEs are estimated to contribute over $48 million in excess annual costs.

Postoperative AEs following lobectomy impose substantial financial burdens, with PAL alone accounting for more than half of total costs. These findings underscore the need for value-based QI initiatives targeting high-impact AEs, requiring coordinated action among surgeons, hospital leadership, and policymakers.

The rising cost of healthcare and the economic burden of adverse events (AEs) following thoracic surgery remains a significant challenge in the delivery of value-based care for patients with lung cancer.