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

Abstract

Objectives: 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. Methods: 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$). Results: 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. Conclusions: 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.