Schuster Martin, Standl Thomas, Wagner Joachim A, Berger Jürgen, Reimann Hajo, Am Esch Jochen Schulte
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Anesthesiology. 2004 Dec;101(6):1435-43. doi: 10.1097/00000542-200412000-00026.
Little is known about differences in costs to provide anesthesia care for different surgical subspecialties and which factors influence the subspecialty-specific costs.
In this retrospective study, the authors determined main cost components (preoperative visit, intraoperative personnel costs, material and pharmaceutical costs, and others) for 10,843 consecutive anesthesia cases from a 6-month period in the 10 largest anesthesia subspecialties in their university hospital: ophthalmology; general surgery; obstetrics and gynecology; ear, nose, and throat surgery; oral and facial surgery; neurosurgery; orthopedics; cardiovascular surgery; traumatology; and urology. Using regression analysis, the effect of five presumed cost drivers (anesthesia duration, emergency status, American Society of Anesthesiologists physical status of III or higher, patient age younger 6 yr, and placement of invasive monitoring) on subspecialty-specific costs per anesthesia minute were analyzed.
Both personnel costs for anesthesiologists and total costs calculated per anesthesia minute were inversely correlated with the duration of anesthesia (adjusted R2 = 0.75 and 0.69, respectively), i.e., they were higher for subspecialties with short cases and lower for subspecialties with longer cases. The multiple regression model showed that differences in anesthesia duration alone accounted for the majority of the cost differences, whereas the other presumed cost drivers added only little to explain subspecialty-specific cost differences.
Different anesthesia subspecialties show significant and financially important differences regarding their specific costs. Personnel costs and total costs are highest for subspecialties with the shortest cases. Other analyzed cost drivers had little effect on subspecialty-specific costs. In the light of these cost differences, a detailed cost analysis seems necessary before the profitability of an anesthesia subspecialty can be assessed.
对于为不同外科亚专业提供麻醉护理的成本差异以及哪些因素影响特定亚专业成本，人们了解甚少。
在这项回顾性研究中，作者确定了大学医院10个最大麻醉亚专业在6个月期间连续10843例麻醉病例的主要成本组成部分（术前访视、术中人员成本、材料和药品成本等）：眼科；普通外科；妇产科；耳鼻喉科手术；口腔颌面外科；神经外科；骨科；心血管外科；创伤科；泌尿外科。使用回归分析，分析了五个假定成本驱动因素（麻醉持续时间、急诊状态、美国麻醉医师协会身体状况为III级或更高、患者年龄小于6岁以及侵入性监测的放置）对每麻醉分钟特定亚专业成本的影响。
麻醉医师的人员成本和每麻醉分钟计算的总成本均与麻醉持续时间呈负相关（调整后的R2分别为0.75和0.69），即短病例亚专业的成本较高，长病例亚专业的成本较低。多元回归模型表明，仅麻醉持续时间的差异就占成本差异的大部分，而其他假定的成本驱动因素对解释特定亚专业成本差异的贡献很小。
不同的麻醉亚专业在其特定成本方面存在显著且在财务上具有重要意义的差异。病例最短的亚专业的人员成本和总成本最高。其他分析的成本驱动因素对特定亚专业成本的影响很小。鉴于这些成本差异，在评估麻醉亚专业的盈利能力之前，进行详细的成本分析似乎是必要的。
