Gani Faiz, Hundt John, Makary Martin A, Haider Adil H, Zogg Cheryl K, Pawlik Timothy M
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2016 Apr;23(4):1064-70. doi: 10.1245/s10434-015-5042-x. Epub 2015 Dec 29.
Despite increasing efforts for cost containment, little is known regarding the financial implications of postoperative complication under current volume-driven payment paradigms. This study sought the test the associations between hospital finances and postoperative complications among hepato-pancreatico-bilary cancer patients.
Patients undergoing surgery for the management of a hepatobiliary or pancreatic cancer between January 1, 2009 and December 31, 2013 were identified using institutional claims and cost-accounting data. Multivariable linear regression analyses were used to calculate risk-adjusted fixed and variable costs, payments, and net margins.
A total of 1483 met inclusion criteria. Fixed ($9290 [interquartile range (IQR) $7129-$11,598] vs. $14,784 [IQR $10,523-$22,799], p < 0.001) and variable costs ($12,342 [IQR $9886-$14,762] vs. $19,330 [IQR $13,967-$29,435], p < 0.001) were higher among patients who developed a postoperative complication following a hepatectomy. A higher contribution margin ($12,421 [IQR $8440-$16,445] vs. $20,016 [IQR $14,212-$39,179], p < 0.001), as well as a twofold higher net profit was noted among patients who developed postoperative complication ($2788 [IQR $660-$5815] vs. $5515 [IQR $1068-$10,315], p < 0.001). Total hospital costs ($26,840 [IQR $21,318-$35,358] vs. $46,628 [IQR $31,974-$69,326], p < 0.001) as well as payments ($32,761 [IQR $26,394-$41,883] vs. $53,612 [IQR $38,548-$78,116], p < 0.001) were more than 1.5 times higher among patients who developed a postoperative complication following pancreatic resection. Contribution margins ($18,356 [IQR $14,024-$24,390] vs. $29,153 [IQR $20,256-$41,785], p < 0.001), as well as net profits ($5907 [IQR $2179-$9412] vs. $8114 [IQR $2518-$14,249], p < 0.001) were higher among patients who developed postoperative complication following pancreatic surgery.
A positive association was observed between net profits and postoperative complications. Future policies should target complications as a means to achieving a higher value for care.
尽管在控制成本方面做出了越来越多的努力，但在当前以量计费的支付模式下，对于术后并发症的财务影响仍知之甚少。本研究旨在检验肝胆胰癌患者医院财务状况与术后并发症之间的关联。
利用机构索赔和成本核算数据，确定2009年1月1日至2013年12月31日期间接受肝胆或胰腺癌手术治疗的患者。采用多变量线性回归分析来计算风险调整后的固定成本、可变成本、支付费用和净利润率。
共有1483例符合纳入标准。肝切除术后发生并发症的患者，其固定成本（9290美元[四分位间距（IQR）7129 - 11,598美元]对比14,784美元[IQR 10,523 - 22,799美元]，p < 0.001）和可变成本（12,342美元[IQR 9886 - 14,762美元]对比19,330美元[IQR 13,967 - 29,435美元]，p < 0.001）更高。术后发生并发症的患者贡献利润率更高（12,421美元[IQR 8440 - 16,445美元]对比20,016美元[IQR 14,212 - 39,179美元]，p < 0.001），净利润高出两倍（2788美元[IQR 660 - 5815美元]对比5515美元[IQR 1068 - 10,315美元]，p < 0.001）。胰腺切除术后发生并发症的患者，总住院成本（26,840美元[IQR 21,318 - 35,358美元]对比46,628美元[IQR 31,974 - 69,326美元]，p < 0.001）以及支付费用（32,761美元[IQR 26,394 - 41,883美元]对比53,612美元[IQR 38,548 - 78,116美元]，p < 0.001）高出1.5倍以上。胰腺手术后发生并发症的患者贡献利润率（18,356美元[IQR 14,024 - 24,390美元]对比29,153美元[IQR 20,256 - 41,785美元]，p < 0.001）以及净利润（5907美元[IQR 2179 - 9412美元]对比8114美元[IQR 2518 - 14,249美元]，p < 0.001）更高。
观察到净利润与术后并发症之间存在正相关。未来政策应将并发症作为实现更高医疗价值的一种手段。
