Konety Badrinath R, Dhawan Vibhu, Allareddy Veerasathpurush, O'Donnell Michael A
Departments of Urology, University of Iowa, 200 Hawkins Drive, 3RCP, Iowa City, Iowa 52242-1089, USA.
J Urol. 2004 Sep;172(3):1056-61. doi: 10.1097/01.ju.0000136382.51688.21.
We investigated the relationship between provider volume and charges for transurethral bladder tumor resection (TURBT) and radical cystectomy in patients with bladder cancer.
The National Inpatient Sample (1988 to 1999) of the Health Care Utilization Project, and State Ambulatory Surgery Databases for Wisconsin and Florida (2000 data set) were used for analysis. All patients with bladder cancer who had undergone radical cystectomy or TURBT as the principal procedure were identified. Hospitals and surgeons were categorized into terciles of volume based on the average number performed per year. The average hospital charge per discharge/procedure corrected to 2000 levels was calculated. One-way ANOVA with the Bonferroni correction was used to compare charges between different volume levels.
A total of 13,498 patients who underwent radical cystectomy and 5,954 who underwent TURBT were included in the analysis. Charges for radical cystectomy were 5,648 USD lower at high volume hospitals than at low volume hospitals (p <0.001). High volume surgeons were 2,976 USD less expensive than low volume surgeons (p =0.054). For TURBT total hospital charges at high volume hospitals were 1,013 USD more than at low volume hospitals (p <0.0001), while average total hospital charges for procedures performed by high volume surgeons were 919 USD less compared to low volume surgeons (p <0.0001).
High risk inpatient procedures for bladder cancer such as cystectomy, which are more influenced by systems of care, are less expensive to perform at high volume centers. Lower risk ambulatory procedures for bladder cancer, such as TURBT, which are not influenced by systems of care, may be more cost efficiently performed by high volume surgeons at low volume centers.
我们研究了膀胱癌患者经尿道膀胱肿瘤切除术（TURBT）和根治性膀胱切除术的医疗服务提供者手术量与费用之间的关系。
使用医疗保健利用项目的国家住院样本（1988年至1999年）以及威斯康星州和佛罗里达州的州门诊手术数据库（2000年数据集）进行分析。确定所有以根治性膀胱切除术或TURBT作为主要手术的膀胱癌患者。根据每年平均手术量将医院和外科医生分为手术量三分位数。计算校正至2000年水平的每次出院/手术的平均医院费用。采用带有Bonferroni校正的单因素方差分析来比较不同手术量水平之间的费用。
共有13498例接受根治性膀胱切除术的患者和5954例接受TURBT的患者纳入分析。高手术量医院的根治性膀胱切除术费用比低手术量医院低5648美元（p<0.001）。高手术量外科医生的费用比低手术量外科医生便宜2976美元（p=0.054）。对于TURBT，高手术量医院的总住院费用比低手术量医院多1013美元（p<0.0001），而高手术量外科医生进行手术的平均总住院费用比低手术量外科医生少919美元（p<0.0001）。
膀胱癌的高风险住院手术，如膀胱切除术，受医疗系统影响更大，在高手术量中心进行手术成本更低。膀胱癌的低风险门诊手术，如TURBT，不受医疗系统影响，高手术量外科医生在低手术量中心进行手术可能更具成本效益。
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