Department of Health Behavior and Health Systems, School of Public Health, University of North Texas - Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, United States.
Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, United States.
J Clin Anesth. 2017 Sep;41:99-103. doi: 10.1016/j.jclinane.2017.07.003. Epub 2017 Jul 21.
Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital.
Observational study.
State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016.
Inpatients discharged with a major therapeutic ("operative") procedure.
For each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month.
Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (P<0.00001). Average percentage differences were insensitive to the endpoint, with similar results for the percentage of patient days and percentage of DRG case-mix weights.
Approximately 2/3rd (mean 68%) of inpatient costs among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them.
在平均每家医院中，约有 54%的外科出院病例是在该医院每月仅进行一次或不频繁进行的手术程序。我们假设，此类不常见的手术程序将与该医院所有外科手术程序总成本的更大比例相关。
观察性研究。
德克萨斯州医院出院摘要数据：2015 年第四季度和 2016 年第一季度。
出院时伴有主要治疗（“手术”）程序的住院患者。
对于 N=343 家医院中的每一家，都获得了每种手术程序或手术程序组合的出院人数、住院时间（LOS）总和、诊断相关组（DRG）病例组合权重总和以及收费总和，这些手术程序通过国际疾病分类第十版操作编码系统（ICD-10-PCS）进行分类。每个出院病例被分为两类，罕见与非罕见，定义为每月仅进行一次或不频繁进行的手术程序与每月进行多次的手术程序。
每家医院每月仅进行一次的主要手术程序平均占所有主要治疗性手术程序相关住院费用的 68%。平均而言，罕见手术程序与总出院人数相比，其占总成本的比例高出 26%（P<0.00001）。平均百分比差异对终点不敏感，患者住院天数和 DRG 病例组合权重的百分比也存在类似结果。
在外科患者中，约 2/3（平均 68%）的住院费用可归因于每月仅在每家医院进行一次的手术程序。发现此类罕见手术程序占成本的很大比例很重要，因为按手术程序进行成本核算的方法通常不适合此类手术程序。
