Brunelli Alessandro, Drosos Polyvios, Ismail Haaris, Pompili Cecilia, Bassi Vinod
Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
Costing Team, Finance Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Eur J Cardiothorac Surg. 2017 Feb 1;51(2):230-235. doi: 10.1093/ejcts/ezw307.
To detect factors associated with costs of anatomic lung resection without major complications.
Two hundred and fifty consecutive patients submitted to anatomic lung resection (185 by VATS) in 1 fiscal year (1 April 2014–31 March 2015) were included. Thoracic Morbidity and Mortality (TMM) system was used to grade the severity of complications. Two hundred and ten patients who did not develop major complications (TMM < 3) were analysed. Postoperative costs were retrieved from the Financial Department through a Patient Level Information and Costing System. Multivariable regression and bootstrap analyses were used to test the association of several baseline patient characteristics with costs and obtain an aggregate scoring system to estimate postoperative costs.
Among the 210 patients, 117 (56%) did not develop any complication and 93 (44%) had minor complications. Their average postoperative cost was 4040€, significantly lower than the one observed in patients with major complications (13 156€, P < 0.0001). Multivariable regression revealed that open thoracotomy (P = 0.01), carbon monoxide lung diffusion capacity (DLCO) < 60% (P = 0.001) and coronary artery disease (CAD) (P = 0.009) were associated with postoperative costs. Open thoracotomy would increase the cost by 648€, DLCO < 60% by 935€ and CAD by 1043€. If all three factors were present, they would cause an increase of postoperative costs from 3592€ to 6219€.
We were able to identify clinical factors associated with postoperative costs in patients without major complications. Recognizing groups of increased cost may lead to specific process analyses aimed at optimising their pathways of care and ultimately saving money. Moreover, these findings may help administrators to tailor future individualized lung resection reimbursement tariffs based on patient characteristics.
检测与无严重并发症的解剖性肺切除成本相关的因素。
纳入在1个财政年度（2014年4月1日至2015年3月31日）连续接受解剖性肺切除的250例患者（185例通过电视辅助胸腔镜手术）。采用胸科发病率和死亡率（TMM）系统对并发症的严重程度进行分级。分析210例未发生严重并发症（TMM＜3）的患者。通过患者层面信息和成本核算系统从财务部门获取术后成本。采用多变量回归和自助法分析来检验几种基线患者特征与成本之间的关联，并获得一个综合评分系统以估算术后成本。
在这210例患者中，117例（56%）未发生任何并发症，93例（44%）有轻微并发症。他们的平均术后成本为4040欧元，显著低于有严重并发症患者的成本（13156欧元，P＜0.0001）。多变量回归显示，开胸手术（P = 0.01）、一氧化碳肺弥散量（DLCO）＜60%（P = 0.001）和冠状动脉疾病（CAD）（P = 0.009）与术后成本相关。开胸手术会使成本增加648欧元，DLCO＜60%会增加935欧元，CAD会增加1043欧元。如果这三个因素都存在，它们会导致术后成本从3592欧元增加到6219欧元。
我们能够识别无严重并发症患者术后成本相关的临床因素。识别成本增加的群体可能会促使进行特定的流程分析，旨在优化其护理路径并最终节省资金。此外，这些发现可能有助于管理人员根据患者特征制定未来个性化的肺切除报销费率。
