Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Trauma Critical Care and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Surg Endosc. 2018 Dec;32(12):4798-4804. doi: 10.1007/s00464-018-6230-0. Epub 2018 May 17.
The World Society for Emergency Surgery determined that for appendicitis managed with appendectomy, there is a paucity of evidence evaluating costs with respect to disease severity. The American Association for the Surgery of Trauma (AAST) disease severity grading system is valid and generalizable for appendicitis. We aimed to evaluate hospitalization costs incurred by patients with increasing disease severity as defined by the AAST. We hypothesized that increasing disease severity would be associated with greater cost.
Single-institution review of adults (≥ 18 years old) undergoing appendectomy for acute appendicitis during 2010-2016. Demographics, comorbidities, operative details, hospital stay, complications, and institutional cost data were collected. AAST grades were assigned by two independent reviewers based on operative findings. Total cost was ascertained from billing data and normalized to median grade I cost. Non-parametric linear regression was utilized to assess the association of several covariates and cost.
Evaluated patients (n = 1187) had a median [interquartile range] age of 37 [26-55] and 45% (n = 542) were female. There were 747 (63%) patients with Grade I disease, 219 (19%) with Grade II, 126 (11%) with Grade III, 50 (4%) with Grade IV, and 45 (4%) with Grade V. The median normalized cost of hospitalization was 1 [0.9-1.2]. Increasing AAST grade was associated with increasing cost (ρ = 0.39; p < 0.0001). Length of stay exhibited the strongest association with cost (ρ = 0.5; p < 0.0001), followed by AAST grade (ρ = 0.39), Clavien-Dindo Index (ρ = 0.37; p < 0.0001), age-adjusted Charlson score (ρ = 0.31; p < 0.0001), and surgical wound classification (ρ = 0.3; p < 0.0001).
Increasing anatomic severity, as defined by AAST grade, is associated with increasing cost of hospitalization and clinical outcomes. The AAST grade compares favorably to other predictors of cost. Future analyses evaluating appendicitis reimbursement stand to benefit from utilization of the AAST grade.
世界急诊外科学会确定，对于接受阑尾切除术治疗的阑尾炎，在评估疾病严重程度方面的证据很少。美国外科创伤协会（AAST）疾病严重程度分级系统对于阑尾炎是有效的和可推广的。我们旨在评估根据 AAST 定义的疾病严重程度递增的患者的住院费用。我们假设疾病严重程度的增加与成本的增加有关。
对 2010 年至 2016 年间接受阑尾切除术治疗急性阑尾炎的成年患者（≥18 岁）进行单机构回顾。收集人口统计学、合并症、手术细节、住院时间、并发症和机构成本数据。两名独立审查员根据手术结果分配 AAST 等级。从计费数据中确定总费用，并归一化为 I 级费用的中位数。采用非参数线性回归评估几种协变量与成本的关系。
评估的患者（n=1187）的中位年龄[四分位数范围]为 37[26-55]岁，45%（n=542）为女性。747 例（63%）患者为 I 级疾病，219 例（19%）为 II 级疾病，126 例（11%）为 III 级疾病，50 例（4%）为 IV 级疾病，45 例（4%）为 V 级疾病。住院期间的中位归一化费用为 1[0.9-1.2]。AAST 等级的增加与费用的增加相关（ρ=0.39；p<0.0001）。住院时间与费用的相关性最强（ρ=0.5；p<0.0001），其次是 AAST 等级（ρ=0.39）、Clavien-Dindo 指数（ρ=0.37；p<0.0001）、年龄调整 Charlson 评分（ρ=0.31；p<0.0001）和手术切口分类（ρ=0.3；p<0.0001）。
根据 AAST 分级定义的解剖严重程度的增加与住院费用和临床结果的增加相关。AAST 等级与其他成本预测因素相比具有优势。未来评估阑尾炎报销的分析将受益于 AAST 等级的使用。
