Biron Vincent L, Bang Heejung, Farwell D Gregory, Bewley Arnaud F
1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery University of Alberta , Edmonton, Canada .
2 Department of Public Health Sciences, Division of Biostatistics, University of California Davis , Davis, California.
Thyroid. 2015 Jul;25(7):823-9. doi: 10.1089/thy.2014.0495.
Medical costs in the United States have been increasing disproportionally to gross domestic product, raising concerns about the sustainability of U.S. healthcare expenditures. Care of patients with thyroid disease has been identified as an area of medicine where cost increases have been pronounced.
The goals of this study were to identify potential drivers of the cost of hospitalization following thyroid surgery, and to understand which of these factors may be contributing to observed increases in cost from 2003 to 2011.
A retrospective cross-sectional analysis of discharge data from the Nationwide Inpatient Sample (NIS) database for all admissions following thyroid lobectomy or total thyroidectomy in the years 2003, 2007, and 2011 was performed. Multiple regression analysis via a weighted generalized linear model was used to identify factors that were independently associated with high cost of hospitalization. Trend as well as subgroup analyses were then performed to identify which of these factors could be contributing to increasing costs.
There were 47,854 hospital admissions following total thyroidectomy or thyroid lobectomy identified in the years 2003, 2007, and 2011. The aggregate national cost of hospitalization increased from $198 million in 2003 to $373 million in 2011 in inflation-adjusted 2011 dollars. The weighted mean cost of hospitalization following thyroid surgery increased from $6154 to $8982 from 2003 to 2011 in inflation-adjusted 2011 dollars. Higher comorbidity score, total thyroidectomy, lymphadenectomy, western region, rural region, and certain postoperative complications were the factors most highly associated with increased hospital costs. Of these, an increasing proportion of patients with higher severity of illness score and an increasing proportion of patients undergoing total thyroidectomy and lymphadenectomy were implicated as the most likely contributors to the cost increases. The rate of total thyroidectomy and lymphadenectomy was found to be increasing for patients with both benign and malignant thyroid disease.
According to the NIS data set, costs associated with hospitalization after thyroid surgery increased markedly from 2003 to 2011. This increase could be in part due to a growing proportion of sicker patients undergoing more extensive surgery, but a number of confounders in this study limit the conclusions. Further analysis of factors that could be associated with the rising costs of inpatient thyroid surgery should be undertaken.
美国的医疗成本增长与国内生产总值不成比例，这引发了人们对美国医疗支出可持续性的担忧。甲状腺疾病患者的护理已被确定为医疗成本增长显著的领域。
本研究的目的是确定甲状腺手术后住院费用的潜在驱动因素，并了解这些因素中哪些可能导致了2003年至2011年观察到的成本增加。
对2003年、2007年和2011年全国住院患者样本（NIS）数据库中甲状腺叶切除术或全甲状腺切除术后所有住院患者的出院数据进行回顾性横断面分析。通过加权广义线性模型进行多元回归分析，以确定与高住院成本独立相关的因素。然后进行趋势分析和亚组分析，以确定这些因素中哪些可能导致成本增加。
2003年、2007年和2011年共确定了47854例全甲状腺切除术或甲状腺叶切除术后的住院病例。以2011年通货膨胀调整后的美元计算，全国住院总费用从2003年的1.98亿美元增加到2011年的3.73亿美元。以2011年通货膨胀调整后的美元计算，甲状腺手术后住院的加权平均费用从2003年的6154美元增加到2011年的8982美元。更高的合并症评分、全甲状腺切除术、淋巴结清扫术、西部地区、农村地区以及某些术后并发症是与住院成本增加高度相关的因素。其中，病情严重程度评分较高的患者比例增加以及接受全甲状腺切除术和淋巴结清扫术的患者比例增加被认为是成本增加的最可能原因。发现良性和恶性甲状腺疾病患者的全甲状腺切除术和淋巴结清扫率均在上升。
根据NIS数据集，2003年至2011年甲状腺手术后的住院相关成本显著增加。这种增加可能部分归因于病情较重的患者接受更广泛手术的比例增加，但本研究中的一些混杂因素限制了结论。应进一步分析可能与甲状腺手术住院成本上升相关的因素。
