Kuei Andrew, Lee Edward Wolfgang, Saab Sammy, Busuttil Ronald W, Durazo Francisco, Han Steven-Huy, ElKabany Mohamed, McWilliams Justin P, Kee Stephen T
Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA.
Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA.
Dig Dis Sci. 2016 Oct;61(10):2838-2846. doi: 10.1007/s10620-016-4233-z. Epub 2016 Jun 27.
Despite widespread use of transjugular intrahepatic portosystemic shunt (TIPS) for treatment of portal hypertension, a paucity of nationwide data exists on predictors of the economic impact related to TIPS.
Using the National Inpatient Sample (NIS) database from 2001 to 2012, we aimed to evaluate factors contributing to hospital cost of patients admitted to US hospitals for TIPS.
Using the NIS, we identified a discharge-weighted national estimate of 61,004 TIPS procedures from 2001 to 2012. Through independent sample analysis, we determined profile factors related to increases in hospital costs.
Of all TIPS cases, the mean charge adjusted for inflation to the year 2012 is $125,044 ± $160,115. The mean hospital cost adjusted for inflation is $44,901 ± $54,565. Comparing pre- and post-2005, mean charges and cost have increased considerably ($98,154 vs. $142,652, p < 0.001 and $41,656 vs. $46,453, p < 0.001, respectively). Patients transferred from a different hospital, weekend admissions, Asian/Pacific Islander patients, and hospitals in the Northeastern and Western region had higher cost. Number of diagnoses and number of procedures show positive correlations with hospital cost, with number of procedures exhibiting stronger relationships (Pearson 0.613). Comorbidity measures with highest increases in cost were pulmonary circulation disorders ($32,157 increase, p < 0.001).
The cost of the TIPS procedure is gradually rising for hospitals. Alongside recent healthcare reform through the Affordable Care Act, measures to reduce the economic burden of TIPS are of increasing importance. Data from this study are intended to aid physicians and hospitals in identifying improvements that could reduce hospital costs.
尽管经颈静脉肝内门体分流术（TIPS）广泛用于治疗门静脉高压症，但关于TIPS相关经济影响预测因素的全国性数据却很匮乏。
利用2001年至2012年的全国住院患者样本（NIS）数据库，我们旨在评估导致美国医院因TIPS入院患者住院费用的因素。
利用NIS，我们确定了2001年至2012年61,004例TIPS手术的出院加权全国估计数。通过独立样本分析，我们确定了与住院费用增加相关的特征因素。
在所有TIPS病例中，经通胀调整至2012年的平均费用为125,044美元±160,115美元。经通胀调整的平均住院费用为44,901美元±54,565美元。比较2005年前后，平均费用和成本大幅增加（分别为98,154美元对142,652美元，p<0.001；41,656美元对46,453美元，p<0.001）。从不同医院转来的患者、周末入院患者、亚太岛民患者以及东北部和西部地区的医院费用更高。诊断数量和手术数量与住院费用呈正相关，手术数量的相关性更强（Pearson相关系数为0.613）。成本增加最高的合并症是肺循环障碍（增加32,157美元，p<0.001）。
TIPS手术对医院来说成本在逐渐上升。随着近期通过《平价医疗法案》进行的医疗改革，减轻TIPS经济负担的措施变得越来越重要。本研究的数据旨在帮助医生和医院确定可降低住院成本的改进措施。
