Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio.
Data and Analytic Resources, Covidien, Mansfield, Massachusetts.
JAMA Surg. 2015 May;150(5):410-5. doi: 10.1001/jamasurg.2014.3171.
Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated.
To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study.
Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization.
Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy.
Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.
腹腔镜结直肠切除术在治疗许多结直肠疾病方面是安全有效的。然而，腹腔镜使用的增加对整体医疗保健利用和成本的影响，特别是在长期，尚未得到彻底调查。
评估腹腔镜与开腹结直肠切除术对短期和长期医疗保健利用和成本的影响。
设计、设置和参与者：使用全国健康保险索赔数据的回顾性多变量回归分析评估了选择性结直肠切除术 1 年内的医疗保健利用和成本。数据来自 Truven Health Analytics MarketScan 商业索赔和就诊数据库。纳入年龄在 18 至 64 岁之间、2010 年 1 月 1 日至 2010 年 12 月 31 日期间接受选择性腹腔镜或开腹结直肠切除术的患者。排除需要增加非手术相关医疗保健利用的复杂诊断的患者，包括恶性肿瘤、炎症性肠病、人类免疫缺陷病毒、移植和怀孕。在接受结直肠切除术的 25481 例患者中，有 4160 例被纳入研究。
术后 90 天和 365 天的医疗保健利用情况，包括门诊、医院门诊和急诊就诊以及住院服务；总医疗保健费用；以及因医疗保健利用而缺勤的估计天数。
在接受结直肠切除术的 25481 例患者中，有 4160 例被纳入研究（腹腔镜组 45.6%，开腹组 54.4%）。腹腔镜组的净付款（$23064 [$14558]）和总付款（$24196 [$14507]）均低于开腹组。在术后 90 天内，开放方法与医疗保健成本增加（估计为$1715；95%CI，$338-$2853）、更多医疗保健服务的使用和更多估计的缺勤天数（2.78 天；95%CI，1.93-3.59）显著相关。在整个术后年度也出现了类似的趋势，腹腔镜组的医疗保健支出估计增加了 1.18 倍（95%CI，1.04-1.35），而医疗保健利用天数增加了 1.15 倍（95%CI，1.08-1.23）。
