Ramirez Alvaro, Benayoun Serge, Briganti Alberto, Chun Jongi, Perrotte Paul, Kattan Michael W, Graefen Markus, McCormack Michael, Neugut Alfred I, Saad Fred, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
Eur Urol. 2006 Jul;50(1):58-62; discussion 62-3. doi: 10.1016/j.eururo.2006.02.066. Epub 2006 Mar 27.
To test the hypothesis that individual surgical volume (SV) is an independent predictor of radical prostatectomy (RP) total charges.
We used the Florida State Inpatient Data File. ICD-9 codes 60.5 (RP) and 185 (prostate cancer) identified all men treated with RP for prostate cancer between January 1 and December 31, 1998. Among 1,923,085 records, 3167 RPs were selected. SV represented the predictor. Total RP charges represented the outcome. Age, race, and comorbidity represented covariates. Univariate and multivariate linear regression models were used.
All 3167 RPs were performed by 81 surgeons. SV ranged from 2 to 162 (mean, 68). Charges were 4755 dollars to 140,201 dollars (mean, 18,200 dollars). In the multivariate model, each SV increment corresponding to one RP reduced hospital charges by 25 dollars (p < or = 0.001).
Redistribution of RPs from low to high SV users could result in significant savings. For example, 4 million dollars could be saved if 1000 RPs were redistributed from surgeons with an SV of 18 to surgeons with an SV of 200.
检验个体手术量（SV）是前列腺癌根治术（RP）总费用独立预测因素这一假设。
我们使用了佛罗里达州住院患者数据文件。ICD - 9编码60.5（RP）和185（前列腺癌）确定了1998年1月1日至12月31日期间所有接受RP治疗前列腺癌的男性患者。在1,923,085条记录中，选取了3167例RP手术。SV作为预测因素，RP总费用作为结果变量。年龄、种族和合并症作为协变量。使用单变量和多变量线性回归模型。
所有3167例RP手术由81名外科医生完成。SV范围为2至162（平均为68）。费用为4755美元至140,201美元（平均为18,200美元）。在多变量模型中，每增加一例RP对应的SV会使住院费用降低25美元（p≤0.001）。
将RP手术从低手术量使用者重新分配给高手术量使用者可显著节省费用。例如，如果将1000例RP手术从手术量为18的外科医生重新分配给手术量为200的外科医生，可节省400万美元。
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