Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Urol. 2016 Oct;196(4):1090-5. doi: 10.1016/j.juro.2016.04.087. Epub 2016 May 6.
We assessed surgeon and hospital level variation in robot-assisted radical prostatectomy costs and predictors of high and low cost surgery.
The study population consisted of a weighted sample of 291,015 men who underwent robot-assisted radical prostatectomy for prostate cancer by 667 surgeons at 197 U.S. hospitals from 2003 to 2013. We evaluated 90-day direct hospital costs (2014 USD) in the Premier Hospital Database. High costs per robot-assisted radical prostatectomy were those above the 90th percentile and low costs were those below the 10th percentile.
Mean hospital cost per robot-assisted radical prostatectomy was $11,878 (95% CI $11,804-$11,952). Mean cost was $2,837 (95% CI $2,805-$2,869) in the low cost group vs $25,906 (95% CI $24,702-$25,490) in the high cost group. Nearly a third of the variation in robot-assisted radical prostatectomy cost was attributable to hospital characteristics and more than a fifth was attributable to surgeon characteristics (R-squared 30.43% and 21.25%, respectively). High volume surgeons and hospitals (90th percentile or greater) had decreased odds of high cost surgery (surgeons: OR 0.24, 95% CI 0.11-0.54; hospitals: OR 0.105, 95% CI 0.02-0.46). The performance of robot-assisted radical prostatectomy at a high volume hospital was associated with increased odds of low cost robot-assisted radical prostatectomy (OR 839, 95% CI 122-greater than 999).
This study provides insight into the role of surgeons and hospitals in robot-assisted radical prostatectomy costs. Given the substantial variability, identifying and remedying the root cause of outlier costs may yield substantial benefits.
我们评估了外科医生和医院层面在机器人辅助前列腺根治性切除术费用方面的差异，以及高成本和低成本手术的预测因素。
研究人群由 2003 年至 2013 年间在美国 197 家医院由 667 名外科医生为前列腺癌行机器人辅助前列腺根治性切除术的 291015 名男性的加权样本组成。我们评估了 Premier 医院数据库中 90 天的直接医院费用（2014 年美元）。每例机器人辅助前列腺根治性切除术的高成本是指高于第 90 百分位的成本，低成本是指低于第 10 百分位的成本。
机器人辅助前列腺根治性切除术的平均医院费用为 11878 美元（95%CI 11804-11952）。低费用组的平均费用为 2837 美元（95%CI 2805-2869），高费用组为 25906 美元（95%CI 24702-25490）。机器人辅助前列腺根治性切除术费用的近三分之一归因于医院特征，超过五分之一归因于外科医生特征（R-平方值分别为 30.43%和 21.25%）。高容量外科医生和医院（第 90 百分位或更高）行高成本手术的可能性降低（外科医生：比值比 0.24，95%CI 0.11-0.54；医院：比值比 0.105，95%CI 0.02-0.46）。在高容量医院行机器人辅助前列腺根治性切除术与低费用机器人辅助前列腺根治性切除术的可能性增加相关（比值比 839，95%CI 122-大于 999）。
本研究深入探讨了外科医生和医院在机器人辅助前列腺根治性切除术费用方面的作用。鉴于存在大量的差异，确定和纠正异常成本的根本原因可能会带来巨大的收益。
