Boehme Jacqueline, McKinley Sophia, Michael Brunt L, Hunter Tina D, Jones Daniel B, Scott Daniel J, Schwaitzberg Steven D
Harvard Medical School, Boston, MA, USA.
Washington University School of Medicine, St. Louis, MO, USA.
Surg Endosc. 2016 Jun;30(6):2217-30. doi: 10.1007/s00464-015-4481-6. Epub 2015 Oct 1.
An understanding of the relationship between patient factors and healthcare resource utilization represents a major point of interest for optimizing clinical care and overall net savings, yet maintaining financial margins for provider revenues. This study aims to review resource utilization after cholecystectomy in order to characterize patient factors associated with increased postoperative ED visits and 30-day readmissions.
A total of 53,632 open and laparoscopic cholecystectomies were reviewed from July 2009 to December 2010 in a large private payer claims database. ICD-9 and CPT codes were available for each event, as well as basic demographics. Data regarding 30-day postoperative resource utilization metrics (emergency department visits and inpatient hospitalizations) were analyzed and stratified by key patient comorbidities. Differences between subgroups were evaluated with univariate and multivariable methods.
Of the 53,632 patients studied, 71.2 % (38,171) were female and 28.8 % (15,461) male. Resource utilization within 30 days of surgery included: 6.6 % (3538) of patients with an ED visit and 7.7 % (4103) with an inpatient hospitalization. The most common comorbidities in the study population were: hypertension, hyperlipidemia, GERD/hiatal hernia, and diabetes mellitus. Patients with heart failure, cirrhosis, and a history of MI or acute ischemic heart disease all had a significant association with postoperative ED visit and the highest likelihood of inpatient hospitalization. Angina, diabetes, and hypertension similarly increased both ED utilization and inpatient readmissions to a lesser but still significant extent. Although patients with GERD/hiatal hernia and sleep apnea had a significant association with ED use, they did not have an increased likelihood of readmission.
Patient comorbidity indexing plays a major role in clinical risk stratification and resource utilization for cholecystectomy. These factors should be considered in bundled reimbursement packages and in the creation of preventive postoperative ambulatory strategies given their role in determining potential resource utilization in the postoperative setting.
了解患者因素与医疗资源利用之间的关系是优化临床护理和实现总体净节约的一个主要关注点，同时还要维持医疗服务提供者收入的财务利润。本研究旨在回顾胆囊切除术后的资源利用情况，以确定与术后急诊就诊和30天再入院率增加相关的患者因素。
在一个大型私人医保理赔数据库中，回顾了2009年7月至2010年12月期间总共53,632例开放式和腹腔镜胆囊切除术。每个事件都有ICD-9和CPT编码以及基本人口统计学数据。分析了术后30天资源利用指标（急诊就诊和住院治疗）的数据，并按关键患者合并症进行分层。采用单变量和多变量方法评估亚组之间的差异。
在研究的53,632例患者中，71.2%（38,171例）为女性，28.8%（15,461例）为男性。手术30天内的资源利用情况包括：6.6%（3538例）的患者有急诊就诊，7.7%（4103例）的患者有住院治疗。研究人群中最常见的合并症为：高血压、高脂血症、胃食管反流病/食管裂孔疝和糖尿病。心力衰竭、肝硬化以及有心肌梗死或急性缺血性心脏病病史的患者与术后急诊就诊以及住院治疗的可能性最高均有显著关联。心绞痛、糖尿病和高血压同样在较小但仍显著的程度上增加了急诊利用和住院再入院率。虽然胃食管反流病/食管裂孔疝和睡眠呼吸暂停患者与急诊使用有显著关联，但他们的再入院可能性并未增加。
患者合并症指数在胆囊切除术的临床风险分层和资源利用中起主要作用。鉴于这些因素在确定术后潜在资源利用方面的作用，在捆绑式报销方案以及制定预防性术后门诊策略时应予以考虑。
