Divison of Surgical Oncology, Suite 3010, Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA.
Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA.
Ann Surg Oncol. 2018 Dec;25(13):3804-3811. doi: 10.1245/s10434-018-6758-1. Epub 2018 Sep 14.
Outcomes for pancreatic resection have been studied extensively due to the high morbidity and mortality rates, with high-volume centers achieving superior outcomes. Ongoing investigations include healthcare costs, given the national focus on reducing expenditures. Therefore, we sought to evaluate the relationships between pancreatic surgery costs with perioperative outcomes and volume status.
We performed a retrospective analysis of 27,653 patients who underwent elective pancreatic resections from October 2013 to June 2017 using the Vizient database. Costs were calculated from charges using cost-charge ratios and adjusted for geographic variation. Generalized linear modeling adjusting for demographic, clinical, and operation characteristics was performed to assess the relationships between cost and length of stay, complications, in-hospital mortality, readmissions, and hospital volume. High-volume centers were defined as hospitals performing ≥ 19 operations annually.
The unadjusted mean cost for pancreatic resection and corresponding hospitalization was $20,352. There were no differences in mean costs for pancreatectomies performed at high- and low-volume centers [- $1175, 95% confidence interval (CI) - $3254 to $904, p = 0.27]. In subgroup analysis comparing adjusted mean costs at high- and low-volume centers, there was no difference among patients without an adverse outcome (- $99, 95% CI - $1612 to 1414, p = 0.90), one or more adverse outcomes (- $1586, 95% CI - $4771 to 1599, p = 0.33), or one or more complications (- $2835, 95% CI - $7588 to 1919, p = 0.24).
While high-volume hospitals have fewer adverse outcomes, there is no relationship between surgical volume and costs, which suggests that, in itself, surgical volume is not an indicator of improved healthcare efficiency reflected by lower costs. Patient referral to high-volume centers may not reduce overall healthcare expenditures for pancreatic operations.
由于胰腺切除术的高发病率和死亡率，其术后结果已得到广泛研究，高容量中心的手术效果更为优越。鉴于国家对降低支出的关注，目前正在进行包括医疗保健费用在内的持续调查。因此，我们试图评估胰腺手术成本与围手术期结果和手术量之间的关系。
我们使用 Vizient 数据库对 2013 年 10 月至 2017 年 6 月期间接受择期胰腺切除术的 27653 名患者进行了回顾性分析。使用费用与收费比率计算成本，并根据地理位置差异进行调整。使用广义线性模型调整人口统计学、临床和手术特征，以评估成本与住院时间、并发症、院内死亡率、再入院率和医院容量之间的关系。高容量中心定义为每年实施≥19 例手术的医院。
胰腺切除术和相应住院治疗的未经调整平均费用为 20352 美元。高容量和低容量中心进行的胰腺切除术的平均费用没有差异[-1175 美元，95%置信区间（CI）-3254 至 904 美元，p=0.27]。在比较高容量和低容量中心调整后的平均费用的亚组分析中，无不良结果的患者之间没有差异[-99 美元，95%CI-1612 至 1414 美元，p=0.90]，有一个或多个不良结果[-1586 美元，95%CI-4771 至 1599 美元，p=0.33]，或有一个或多个并发症[-2835 美元，95%CI-7588 至 1919 美元，p=0.24]。
虽然高容量医院的不良结果较少，但手术量与成本之间没有关系，这表明手术量本身并不是成本降低反映的提高医疗保健效率的指标。将患者转介到高容量中心可能不会降低胰腺手术的整体医疗保健支出。
