Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
Department of Financial Services, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
World J Surg. 2020 Jan;44(1):108-114. doi: 10.1007/s00268-019-05184-8.
Data on the association of high preoperative healthcare utilization and adverse clinical outcomes are scarce. We sought to evaluate the role of annual preoperative expenditure (APE) as a surrogate for latent variables of risk for adverse short-term postoperative outcomes.
Low and super-utilizers who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, colectomy, total hip arthroplasty, total knee arthroplasty, or lung resection between 2013 and 2015 were identified from 100% Medicare Inpatient Standard Analytic Files. To assess the association between APE and postoperative outcomes, multivariable logistic regression was utilized.
Among 1,049,160 patients, 788,488 (75.1%) and 21,700 (2.1%) patients were preoperative low- and super-utilizers, respectively. Median APE was more than 60 times higher among super-utilizers than low-utilizers ($57,160 vs. $932), as was the cost of the surgical episode ($21,141 vs. $13,179). The predictive ability of APE ranged from 0.683 (95% CI 0.678-0.687) for 90-day readmission to 0.882 (95% CI 0.879-0.886) for a complication at the index hospitalization. Among super-utilizers, the odds of a complication during the surgical episode was nearly double versus low-utilizers (OR = 1.96, 95% CI 1.89-2.04). Super-utilizers also had an increased odds of 30-day readmission (OR = 1.64, 95% CI 1.58-1.69) and mortality (OR = 2.22; 95% CI 2.04-2.42).
APE was able to predict adverse postsurgical outcomes including complications during the surgical episode, readmission, and 90-day mortality. APE should be considered in the assessment of patient populations when defining risk of adverse postoperative events.
关于高术前医疗保健利用与不良临床结局之间关联的数据较为匮乏。我们旨在评估年度术前支出（APE）作为评估不良短期术后结局风险的潜在变量的替代指标。
从 2013 年至 2015 年 100%的医疗保险住院标准分析文件中，确定接受腹主动脉瘤修复术、冠状动脉旁路移植术、结肠切除术、全髋关节置换术、全膝关节置换术或肺切除术的低利用者和超高利用者。利用多变量逻辑回归评估 APE 与术后结局之间的关联。
在 1049160 例患者中，788488 例（75.1%）和 21700 例（2.1%）患者分别为术前低利用者和超高利用者。与低利用者相比，超高利用者的 APE 中位数高出 60 多倍（57160 美元对 932 美元），手术费用也高出 60 多倍（21141 美元对 13179 美元）。APE 的预测能力从 90 天再入院的 0.683（95%CI 0.678-0.687）到指数住院期间并发症的 0.882（95%CI 0.879-0.886）不等。在超高利用者中，手术期间发生并发症的可能性几乎是低利用者的两倍（比值比=1.96，95%CI 1.89-2.04）。超高利用者 30 天再入院的可能性也增加（比值比=1.64，95%CI 1.58-1.69），死亡率也增加（比值比=2.22；95%CI 2.04-2.42）。
APE 能够预测不良术后结局，包括手术期间的并发症、再入院和 90 天死亡率。在评估不良术后事件风险时，应考虑 APE 在患者人群评估中的作用。
