Mossanen Matthew, Krasnow Ross E, Lipsitz Stuart R, Preston Mark A, Kibel Adam S, Ha Albert, Gore John L, Smith Angela B, Leow Jeffrey J, Trinh Quoc-Dien, Chang Steven L
Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
BJU Int. 2018 Mar;121(3):428-436. doi: 10.1111/bju.14064. Epub 2017 Nov 16.
To quantify the financial impact of complications after radical cystectomy (RC) and their associations with respective 90-day costs, as RC is a morbid surgery plagued by complications and the expenditure attributed to specific complications after RC is not well characterised.
We used the Premier Hospital Database (Premier Inc., Charlotte, NC, USA) to identify 9 137 RC patients (weighted population of 57 553) from 360 hospitals between 2003 and 2013. Complications were categorised according to Agency for Healthcare Research and Quality Clinical Classifications. Patients with and without complications were compared, and multivariable analysis was performed.
An index complication increased costs by $9 262 (95% confidence interval [CI] 8 300-10 223) and a readmission complication increased costs by $20 697 (95% CI 18 735-22 660). The four most costly index complications (descending order) were venous thromboembolism (VTE), infection, wound and soft tissue complications, and pulmonary complications (P < 0.001, vs no complication). A complication increased length of stay by 4 days (95% CI 3.6-4.3). One in five patients were readmitted in 90 days and the four costliest readmission complications (descending order) were pulmonary, bleeding, VTE, and gastrointestinal complications (P < 0.001, vs no complication). Readmitted patients had multiple complications upon readmission (median of 3, interquartile range 2-4). On multivariable analysis, more comorbidities, longer surgery (>6 h), transfusions of >3 units, and teaching hospitals were associated with higher costs (P < 0.05), whilst high-volume surgeons and shorter surgeries (<4 h) were associated with lower costs (P < 0.05).
Complications after RC increase index and readmission costs for hospitals, and can be categorised based on magnitude. Future initiatives in RC may also consider costs of complications when establishing quality improvement priorities for patients, providers, or policymakers.
根治性膀胱切除术（RC）后并发症的经济影响及其与90天成本的相关性量化研究，因为RC是一种受并发症困扰的高风险手术，且RC术后特定并发症的费用情况尚无明确描述。
我们使用美国北卡罗来纳州夏洛特市Premier公司的Premier医院数据库，从2003年至2013年期间的360家医院中识别出9137例RC患者（加权人口数为57553）。并发症根据医疗保健研究与质量机构临床分类进行分类。对有并发症和无并发症的患者进行比较，并进行多变量分析。
一种主要并发症使成本增加9262美元（95%置信区间[CI]8300 - 10223），再次入院并发症使成本增加20697美元（95%CI 18735 - 22660）。四种成本最高的主要并发症（按降序排列）为静脉血栓栓塞（VTE）、感染、伤口及软组织并发症和肺部并发症（与无并发症相比，P < 0.001）。并发症使住院时间延长4天（95%CI 3.6 - 4.3）。五分之一的患者在90天内再次入院，四种成本最高的再次入院并发症（按降序排列）为肺部、出血、VTE和胃肠道并发症（与无并发症相比，P < 0.001）。再次入院患者再次入院时存在多种并发症（中位数为3，四分位间距为2 - 4）。多变量分析显示，更多的合并症、更长的手术时间（>6小时）、超过3单位的输血以及教学医院与更高的成本相关（P < 0.05），而高手术量的外科医生和更短的手术时间（<4小时）与更低的成本相关（P < 0.05）。
RC术后并发症增加了医院的主要成本和再次入院成本，且可根据严重程度进行分类。RC未来的举措在为患者、医疗服务提供者或政策制定者确定质量改进重点时，也可考虑并发症的成本。
