The Center for Comprehensive Access & Delivery Research and Evaluation at the Iowa City VA Healthcare System, Iowa City, IA, USA.
J Am Coll Surg. 2012 Jun;214(6):901-8.e1. doi: 10.1016/j.jamcollsurg.2012.01.056. Epub 2012 Apr 11.
Approximately 30% of patients undergoing elective general surgery smoke cigarettes. The association between smoking status and hospital costs in general surgery patients is unknown. The objectives of this study were to compare total inpatient costs in current smokers, former smokers, and never smokers undergoing general surgical procedures in Veterans Affairs (VA) hospitals; and to determine whether the relationship between smoking and cost is mediated by postoperative complications.
Patients undergoing general surgery during the period of October 1, 2005 to September 30, 2006 were identified in the VA Surgical Quality Improvement Program (VASQIP) data set. Inpatient costs were extracted from the VA Decision Support System (DSS). Relative surgical costs (incurred during index hospitalization and within 30 days of operation) for current and former smokers relative to never smokers, and possible mediators of the association between smoking status and cost were estimated using generalized linear regression models. Models were adjusted for preoperative and operative variables, accounting for clustering of costs at the hospital level.
Of the 14,853 general surgical patients, 34% were current smokers, 39% were former smokers, and 27% were never smokers. After controlling for patient covariates, current smokers had significantly higher costs compared with never smokers: relative cost was 1.04 (95% Cl 1.00 to 1.07; p = 0.04); relative costs for former smokers did not differ significantly from those of never smokers: 1.02 (95% Cl 0.99 to 1.06; p = 0.14). The relationship between smoking and hospital costs for current smokers was partially mediated by postoperative respiratory complications.
These findings complement emerging evidence recommending effective smoking cessation programs in general surgical patients and provide an estimate of the potential savings that could be accrued during the preoperative period.
大约 30%接受择期普外科手术的患者吸烟。吸烟状况与普外科患者住院费用之间的关系尚不清楚。本研究的目的是比较在退伍军人事务部（VA）医院接受普外科手术的当前吸烟者、曾经吸烟者和从不吸烟者的总住院费用；并确定吸烟与费用之间的关系是否由术后并发症介导。
在 VA 手术质量改进计划（VASQIP）数据集中确定了在 2005 年 10 月 1 日至 2006 年 9 月 30 日期间接受普外科手术的患者。从 VA 决策支持系统（DSS）中提取住院费用。使用广义线性回归模型估计当前和曾经吸烟者与从不吸烟者的相对手术费用（在指数住院期间和手术 30 天内发生的费用），以及吸烟状况与费用之间关联的可能中介因素。模型调整了术前和手术变量，考虑了医院层面费用的聚类。
在 14853 名普外科患者中，34%是当前吸烟者，39%是曾经吸烟者，27%是从不吸烟者。在控制了患者协变量后，与从不吸烟者相比，当前吸烟者的费用显著增加：相对费用为 1.04（95% Cl 1.00 至 1.07；p = 0.04）；曾经吸烟者的相对费用与从不吸烟者的费用无显著差异：1.02（95% Cl 0.99 至 1.06；p = 0.14）。当前吸烟者与医院费用之间的关系部分由术后呼吸并发症介导。
这些发现补充了推荐在普外科患者中实施有效戒烟计划的新证据，并提供了术前期间可能节省的潜在费用估计。
