Brunelli Alessandro, Drosos Polyvios, Dinesh Padma, Ismail Haaris, Bassi Vinod
Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom.
Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom.
Ann Thorac Surg. 2017 May;103(5):1641-1646. doi: 10.1016/j.athoracsur.2016.10.061. Epub 2017 Feb 9.
The objective of this study was to verify the association between the thoracic mortality and morbidity (TMM) classification system and hospital costs after lung resection.
Consecutive patients (n = 503) submitted to anatomic lung resections were analyzed (April 1, 2014, to March 31, 2016). TMM system was used to grade the severity of complications. Postoperative costs were retrieved from the financial department using an electronic patient-level information system.
Two hundred seventy-two patients (54%) did not experience any complication. The distribution of postoperative complications in the remaining patients according to the TMM classification system was as follows: 57 (25%) grade I, 108 (47%) grade II, 29 (12%) grade III, 17 (7%) grade IV, and 20 (9%) grade V. The average postoperative cost of the uncomplicated patients was $3,560 (95% confidence interval [CI]: $3,440 to $3,680). The average postoperative costs of the patients with complications increased along with the grade of the TMM system; it was $4,548 (95% CI: $4,134 to $4,962) for grade I, $4,909 (95% CI: $4,537 to $5,281) for grade II, $6,392 (95% CI: $5,303 to $7,483) for grade III, and $14,547 (95% CI: $6,334 to $22,760) for grade IV. The average postoperative cost for the patients who eventually died was $17,695 (95% CI: $11,246 to $24,144). Linear regression analysis showed that a prolonged length of hospital stay (p < 0.0001) and an unplanned admission to the intensive care unit (p < 0.0001) were significantly associated with postoperative costs in patients with major complications.
The severity of complications graded by the TMM system was associated with increasing postoperative costs. This instrument may be used to adjust lung resection reimbursement tariffs.
本研究的目的是验证胸段死亡率和发病率（TMM）分类系统与肺切除术后医院费用之间的关联。
分析了连续接受解剖性肺切除术的患者（n = 503）（2014年4月1日至2016年3月31日）。使用TMM系统对并发症的严重程度进行分级。术后费用通过电子患者层面信息系统从财务部门获取。
272例患者（54%）未发生任何并发症。其余患者术后并发症根据TMM分类系统的分布如下：I级57例（25%），II级108例（47%），III级29例（12%），IV级17例（7%），V级20例（9%）。未发生并发症患者的平均术后费用为3560美元（95%置信区间[CI]：3440美元至3680美元）。并发症患者的平均术后费用随着TMM系统分级的增加而增加；I级为4548美元（95%CI：4134美元至4962美元），II级为4909美元（95%CI：4537美元至5281美元），III级为6392美元（95%CI：5303美元至7483美元），IV级为14547美元（95%CI：6334美元至22760美元）。最终死亡患者的平均术后费用为17695美元（95%CI：11246美元至24144美元）。线性回归分析显示，住院时间延长（p < 0.0001）和意外入住重症监护病房（p < 0.0001）与严重并发症患者的术后费用显著相关。
TMM系统分级的并发症严重程度与术后费用增加相关。该工具可用于调整肺切除报销费率。
