Kalsekar Iftekhar, Hsiao Chia-Wen, Cheng Hang, Yadalam Sashi, Chen Brian Po-Han, Goldstein Laura, Yoo Andrew
Medical Devices- Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA.
Franchise Health Economics and Market Access, Ethicon, Inc, Cincinnati, OH, USA.
Health Econ Rev. 2017 Dec;7(1):22. doi: 10.1186/s13561-017-0160-8. Epub 2017 Jun 2.
To determine hospital resource utilization, associated costs and the risk of complications during hospitalization for four types of surgical resections and to estimate the incremental burden among patients with cancer compared to those without cancer.
Patients (≥18 years old) were identified from the Premier Research Database of US hospitals if they had any of the following types of elective surgical resections between 1/2008 and 12/2014: lung lobectomy, lower anterior resection of the rectum (LAR), liver wedge resection, or total hysterectomy. Cancer status was determined based on ICD-9-CM diagnosis codes. Operating room time (ORT), length of stay (LOS), and total hospital costs, as well as frequency of bleeding and infections during hospitalization were evaluated. The impact of cancer status on outcomes (from a hospital perspective) was evaluated using multivariable generalized estimating equation models; analyses were conducted separately for each resection type.
Among the identified patients who underwent surgical resection, 23 858 (87.9% with cancer) underwent lung lobectomy, 13 522 (63.8% with cancer) underwent LAR, 2916 (30.0% with cancer) underwent liver wedge resection and 225 075 (11.3% with cancer) underwent total hysterectomy. After adjusting for patient, procedural, and hospital characteristics, mean ORT, LOS, and hospital cost were statistically higher by 3.2%, 8.2%, and 9.2%, respectively for patients with cancer vs. no cancer who underwent lung lobectomy; statistically higher by 6.9%, 9.4%, and 9.6%, respectively for patients with cancer vs. no cancer who underwent LAR; statistically higher by 4.9%, 14.8%, and 15.7%, respectively for patients with cancer vs. no cancer who underwent liver wedge resection; and statistically higher by 16.0%, 27.4%, and 31.3%, respectively for patients with cancer vs. no cancer who underwent total hysterectomy. Among patients who underwent each type of resection, risks for bleeding and infection were generally higher among patients with cancer as compared to those without cancer.
In this analysis, we found that patients who underwent lung lobectomy, lower anterior resection of the rectum (LAR), liver wedge resection or total hysterectomy for a cancer indication have significantly increased hospital resource utilization compared to these same surgeries for benign indications.
确定四种外科切除术住院期间的医院资源利用情况、相关成本及并发症风险，并估计癌症患者相较于非癌症患者的增量负担。
从美国医院的Premier研究数据库中识别出年龄≥18岁，在2008年1月至2014年12月期间接受以下任何一种择期外科切除术的患者：肺叶切除术、直肠前低位切除术（LAR）、肝楔形切除术或全子宫切除术。根据ICD-9-CM诊断编码确定癌症状态。评估手术室时间（ORT）、住院时间（LOS）、总住院费用以及住院期间出血和感染的频率。使用多变量广义估计方程模型评估癌症状态对（从医院角度看的）结局的影响；对每种切除术类型分别进行分析。
在接受外科切除术的已识别患者中，23858例（87.9%患有癌症）接受了肺叶切除术，13522例（63.8%患有癌症）接受了LAR，2916例（30.0%患有癌症）接受了肝楔形切除术，225075例（11.3%患有癌症）接受了全子宫切除术。在调整患者、手术和医院特征后，接受肺叶切除术的癌症患者与非癌症患者相比，平均ORT、LOS和住院费用分别显著高出3.2%、8.2%和9.2%；接受LAR的癌症患者与非癌症患者相比，分别显著高出6.9%、9.4%和9.6%；接受肝楔形切除术的癌症患者与非癌症患者相比，分别显著高出4.9%、14.8%和15.7%；接受全子宫切除术的癌症患者与非癌症患者相比，分别显著高出16.0%、27.4%和31.3%。在接受每种切除术的患者中，癌症患者的出血和感染风险总体上高于非癌症患者。
在本分析中，我们发现因癌症指征接受肺叶切除术、直肠前低位切除术（LAR）、肝楔形切除术或全子宫切除术的患者，与因良性指征进行相同手术的患者相比，医院资源利用显著增加。
