Real cost of surgery: what are we missing?

Few will disagree that surgery is expensive. Major surgery costs more than minor surgery, and procedures such as oesophagectomy are very expensive. An oesophagectomy can occupy an operating theatre all day, patients require intensive care support, and major complications are common. In this issue, Browning et al. report the cost of surgery for oesophageal cancer, confirm its high cost, and show that complications increase cost.1 Their conclusion that minimizing complications will reduce cost is sound. However, the cost of oesophagectomy is not limited to inpatient costs. Other factors contributing to cost include preoperative workup, chemotherapy and/or radiotherapy before or after surgery, and the impact of time off work for patients and carers.