Won Roy P, Friedlander Scott, Lee Steven L
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California; Los Angeles Biomedical Research Institute, Torrance, California.
Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California; Los Angeles Biomedical Research Institute, Torrance, California.
J Surg Res. 2017 Nov;219:319-324. doi: 10.1016/j.jss.2017.06.051.
The study of regional variations in surgical outcomes and cost has been used to identify areas for improvement and savings. This study investigates potential regional differences in the outcomes and cost of adult appendicitis. We hypothesized that there would be no difference in rates of laparoscopy, perforation, morbidity, length of stay (LOS), and cost among different regions of the United States.
Data were obtained from the California (CA), New York (NY), and Florida (FL) State Inpatient Databases from 2005-2011. Patients between the ages of 18-69 who underwent nonincidental appendectomy in the three different states were evaluated with hierarchical and multivariate negative binomial regression analyses. Primary outcomes included laparoscopy, perforation, negative appendectomy, morbidity, LOS, and cost.
There were 371,354 appendectomies performed. Multivariate analysis revealed multiple regional differences. Patients in FL were most likely to get laparoscopy (P < 0.01). CA had higher rates of perforation than NY (P < 0.01) and FL (P < 0.05). CA also had higher rates of negative appendectomy compared to both NY and FL (P < 0.01). Morbidity was lower in NY compared to CA and FL (P < 0.01). The LOS was shortest in CA (P < 0.01), despite CA having the highest median per patient cost (P < 0.01).
Significant regional variations do exist with CA having the highest rate of perforation and negative appendectomy. Patients in CA also incurred the highest overall costs. A better understanding of the factors that drive these variations will help improve outcomes and lower cost across all states.
对外科手术结果和成本的区域差异进行研究，有助于确定改进和节约成本的领域。本研究调查了成人阑尾炎手术结果和成本方面潜在的区域差异。我们假设在美国不同地区，腹腔镜手术率、穿孔率、发病率、住院时间（LOS）和成本没有差异。
数据来源于2005年至2011年加利福尼亚州（CA）、纽约州（NY）和佛罗里达州（FL）的州住院数据库。对在这三个不同州接受非偶然阑尾切除术的18至69岁患者进行分层和多变量负二项回归分析。主要结果包括腹腔镜手术、穿孔、阴性阑尾切除术、发病率、住院时间和成本。
共进行了371,354例阑尾切除术。多变量分析显示出多个区域差异。佛罗里达州的患者最有可能接受腹腔镜手术（P < 0.01）。加利福尼亚州的穿孔率高于纽约州（P < 0.01）和佛罗里达州（P < 0.05）。与纽约州和佛罗里达州相比，加利福尼亚州的阴性阑尾切除术率也更高（P < 0.01）。纽约州的发病率低于加利福尼亚州和佛罗里达州（P < 0.01）。加利福尼亚州的住院时间最短（P < 0.01），尽管该州每位患者的中位数成本最高（P < 0.01）。
确实存在显著的区域差异，加利福尼亚州的穿孔率和阴性阑尾切除术率最高。加利福尼亚州的患者总体成本也最高。更好地了解导致这些差异的因素将有助于改善所有州的手术结果并降低成本。
