Mehta Ambar, Efron David T, Canner Joseph K, Manukyan Mariuxi C, Dultz Linda, Burns Christopher, Stevens Kent, Sakran Joseph V
Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Johns Hopkins Department of Surgery, Baltimore, Maryland.
J Surg Res. 2018 Jul;227:101-111. doi: 10.1016/j.jss.2018.02.034. Epub 2018 Mar 15.
Patients and hospitals face significant financial burdens from emergency general surgeries (EGSs), which have been termed a public health crisis in the United States. We evaluated hospitalization charges, operating charges, and variations in operating time by surgeon volume for three common EGS procedures.
Using Maryland's Health Services Cost Review Commission database, we performed a retrospective study of laparoscopic appendectomies, laparoscopic cholecystectomies, and open bowel resections performed by general surgeons among adult patients from July 2012 to September 2014. We compared operating charges to total hospitalization charges and quantified variations in operating time for each procedure. We then divided patients into quartiles based on their surgeon's procedure-specific case volume and used hierarchical linear regressions to calculate differences in both operating time and charges between quartiles.
We identified 3194 appendectomies, 4143 cholecystectomies, and 1478 bowel resections. Operating charges accounted for one-quarter (26.9%) of total hospitalization charges and widespread variation existed in operating time (appendectomies: median 79 min [interquartile range 66-100 min], cholecystectomies: 96 min [76-125 min], bowel resections: 155 min [117-209 min]). After adjustment, low-volume surgeons relative to high-volume surgeons did not operate statistically longer for appendectomies (+1%, 95% confidence interval [CI]: -2% to 5%) but operated +16% (95% CI: 12%-20%) longer for cholecystectomies (+14 min) and +40% (95% CI: 30%-50%) longer for bowel resections (+59 min). Adjusted median operating charges from low-volume surgeons relative to high-volume surgeons were $554 (26.7%), $621 (22.0%), and $1801 (47.0%) greater for appendectomies, cholecystectomies, and bowel resections, respectively.
Operating charges contributed substantially to total EGS hospitalization charges, where low-volume surgeons operated longer and had higher operative charges relative to high-volume surgeons. Reducing variations in operating times and charges represents an opportunity to alleviate the financial burden from EGS procedures.
急诊普通外科手术（EGS）给患者和医院带来了巨大的经济负担，在美国，这已被视为一场公共卫生危机。我们评估了三种常见EGS手术的住院费用、手术费用以及不同手术量的外科医生在手术时间上的差异。
利用马里兰州卫生服务成本审查委员会的数据库，我们对2012年7月至2014年9月期间普通外科医生为成年患者实施的腹腔镜阑尾切除术、腹腔镜胆囊切除术和开腹肠切除术进行了回顾性研究。我们将手术费用与总住院费用进行了比较，并对每种手术的手术时间差异进行了量化。然后，我们根据外科医生特定手术的病例数量将患者分为四分位数，并使用分层线性回归来计算四分位数之间手术时间和费用的差异。
我们确定了3194例阑尾切除术、4143例胆囊切除术和1478例肠切除术。手术费用占总住院费用的四分之一（26.9%），手术时间存在广泛差异（阑尾切除术：中位数79分钟[四分位间距66 - 100分钟]，胆囊切除术：96分钟[76 - 125分钟]，肠切除术：155分钟[117 - 209分钟]）。调整后，与高手术量外科医生相比，低手术量外科医生进行阑尾切除术的手术时间在统计学上并没有更长（增加1%，95%置信区间[CI]：-2%至5%），但胆囊切除术的手术时间增加了16%（95% CI：12% - 20%）（增加14分钟），肠切除术的手术时间增加了40%（95% CI：30% - 50%）（增加59分钟）。与高手术量外科医生相比，低手术量外科医生调整后的阑尾切除术、胆囊切除术和肠切除术的中位手术费用分别高出554美元（26.7%）、621美元（22.0%）和1801美元（47.0%）。
手术费用在EGS总住院费用中占很大比例，与高手术量外科医生相比，低手术量外科医生的手术时间更长，手术费用更高。减少手术时间和费用的差异是减轻EGS手术经济负担的一个机会。
