Goense L, van Dijk W A, Govaert J A, van Rossum P S N, Ruurda J P, van Hillegersberg R
Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
X-IS, Delft, The Netherlands.
Eur J Surg Oncol. 2017 Apr;43(4):696-702. doi: 10.1016/j.ejso.2016.11.013. Epub 2016 Dec 5.
The purpose of this study was to estimate the economic burden of postoperative complications after esophagectomy for cancer, in order to optimally allocate resources for quality improvement initiatives in the future.
A retrospective analysis of prospectively collected clinical and financial outcomes after esophageal cancer surgery in a tertiary referral center in the Netherlands was performed. Data was extracted from consecutive patients registered in the Dutch Upper GI Cancer Audit between 2011 and 2014 (n = 201). Costs were measured up to 90-days after hospital discharge and based on Time-Driven Activity-Based Costing. The additional costs were estimated using multiple linear regression models.
The average total cost for one patient after esophagectomy was €37,581 (±31,372). The estimated costs of an esophagectomy without complications were €23,476 (±6496). Mean costs after minor (47%) and severe complications (29%) were €31,529 (±23,359) and €59,167 (±42,615) (p < 0.001), respectively. The 5% most expensive patients were responsible for 20.3% of the total hospital costs assessed in this study. Patient characteristics associated with additional costs in multivariable analysis included, age >70 (+€2,922, p = 0.036), female gender (+€4,357, p = 0.005), COPD (+€5,415, p = 0.002), and a history of thromboembolic events (+€6,213, p = 0.028). Complications associated with a significant increase in costs in multivariable analysis included anastomotic leakage (+€4,123, p = 0.008), cardiac complications (+€5,711, p = 0.003), chyle leakage (+€6,188, p < 0.001) and postoperative bleeding (+€31,567, p < 0.001).
Complications and severity of complications after esophageal surgery are associated with a substantial increase in costs. Although not all postoperative complications can be prevented, implementation of preventive measures to reduce complications could result in a considerable cost reduction and quality improvement.
本研究旨在评估食管癌切除术后并发症的经济负担，以便为未来优化资源配置以提高医疗质量提供依据。
对荷兰一家三级转诊中心前瞻性收集的食管癌手术后临床和财务结果进行回顾性分析。数据来自2011年至2014年在荷兰上消化道癌症审计中登记的连续患者（n = 201）。成本计算至出院后90天，并基于时间驱动作业成本法。使用多元线性回归模型估计额外成本。
食管癌切除术后一名患者的平均总成本为37,581欧元（±31,372）。无并发症的食管癌切除术估计成本为23,476欧元（±6496）。轻度并发症（47%）和重度并发症（29%）后的平均成本分别为31,529欧元（±23,359）和59,167欧元（±42,615）（p < 0.001）。本研究中评估的总医院成本的20.3%由5%费用最高的患者产生。多变量分析中与额外成本相关的患者特征包括年龄>70岁（增加2,922欧元，p = 0.036）、女性（增加4,357欧元，p = 0.005）、慢性阻塞性肺疾病（增加5,415欧元，p = 0.002）和血栓栓塞事件史（增加6,213欧元，p = 0.028）。多变量分析中与成本显著增加相关的并发症包括吻合口漏（增加4,123欧元，p = 0.008）、心脏并发症（增加5,711欧元，p = 0.003）、乳糜漏（增加6,188欧元，p < 0.001）和术后出血（增加31,567欧元，p < 0.001）。
食管手术后并发症及并发症的严重程度与成本大幅增加相关。虽然并非所有术后并发症都能预防，但实施预防措施以减少并发症可显著降低成本并提高医疗质量。
