Lee Jung-A, Kim So-Young, Park Keeho, Park Eun-Cheol, Park Jong-Hyock
Department of Health and Medical Information, School of Arts and Health Care, Myongji College, Seoul, Korea.
Department of Health Information and Management, Chungbuk National University College of Medicine, Cheongju, Korea.
Osong Public Health Res Perspect. 2017 Feb;8(1):34-46. doi: 10.24171/j.phrp.2017.8.1.05. Epub 2017 Feb 28.
To evaluate associations between hospital volume, costs, and length of stay (LOS), and clinical and demographic outcome factors for five types of cancer resection. The main dependent variables were cost and LOS; the primary independent variable was volume.
Data were obtained from claims submitted to the Korean National Health Insurance scheme. We identified patients who underwent the following surgical procedures: pneumonectomy, colectomy, mastectomy, cystectomy, and esophagectomy. Hospital volumes were divided into quartiles.
Independent predictors of high costs and long LOS included old age, low health insurance contribution, non-metropolitan residents, emergency admission, Charlson score > 2, public hospital ownership, and teaching hospitals. After adjusting for relevant factors, there was an inverse relationship between volume and costs/LOS. The highest volume hospitals had the lowest procedure costs and LOS. However, this was not observed for cystectomy.
Our findings suggest an association between patient and clinical factors and greater costs and LOS per surgical oncologic procedure, with the exception of cystectomy. Yet, there were no clear associations between hospitals' cost of care and risk-adjusted mortality.
评估医院手术量、成本和住院时间（LOS）之间的关联，以及五种癌症切除术的临床和人口统计学结果因素。主要因变量为成本和住院时间；主要自变量为手术量。
数据来自提交给韩国国民健康保险计划的索赔申请。我们确定了接受以下手术的患者：肺切除术、结肠切除术、乳房切除术、膀胱切除术和食管切除术。医院手术量分为四分位数。
高成本和长住院时间的独立预测因素包括老年、低健康保险缴费、非大城市居民、急诊入院、查尔森评分>2、公立医院所有权和教学医院。在调整相关因素后，手术量与成本/住院时间之间存在负相关关系。手术量最高的医院手术成本和住院时间最低。然而，膀胱切除术未观察到这种情况。
我们的研究结果表明，除膀胱切除术外，患者和临床因素与每例外科肿瘤手术的更高成本和住院时间之间存在关联。然而，医院护理成本与风险调整后的死亡率之间没有明显关联。
