Wu Si-Yuan, Terrell John, Park Anne, Perrier Nancy
Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
Division of General Surgery, Departments of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
World J Surg. 2020 Feb;44(2):385-392. doi: 10.1007/s00268-019-05176-8.
The cost of thyroidectomy varies across the USA, while the causes of this variation are poorly understood. We examined the cost of inpatient thyroidectomy among National Cancer Institute-designated cancer centers nationwide to determine why it differs.
A retrospective study of inpatient thyroidectomies was performed using the Vizient Clinical Data Base. Fifty-two of 70 eligible hospitals were grouped into five geographic regions (Mid-Atlantic and New England, East Central, South Atlantic, West Central, and Mountain and Pacific). We identified drivers of cost variation in the five geographic regions and used risk adjustment model to evaluate the rationality of cost from each hospital.
Male sex, more extended hospital stays, and occurrence of complications were consistently associated with increased costs in all regions. Also, the cost was significantly lower in the Mid-Atlantic and New England region. The higher than expected costs did not correlate well with the case mix index among hospitals (p = 0.289), but the lower than expected costs were more common in high-volume hospitals. The average length of stay was the shortest in high-volume hospitals, which might account for the lower cost in the Mid-Atlantic and New England region; however, the overages of costs still varied widely among hospitals in all regions even if the length of stay was adjusted.
Cost variation may result from both patient-related factors and volume-related practice pattern differences among hospitals. A more standard of care and charge transparency is still needed for patients seeking affordable care at cancer centers.
在美国，甲状腺切除术的费用因地区而异，但其差异原因尚不清楚。我们调查了全国国立癌症研究所指定的癌症中心的住院甲状腺切除术费用，以确定其为何不同。
使用Vizient临床数据库对住院甲状腺切除术进行回顾性研究。70家符合条件的医院中有52家被分为五个地理区域（中大西洋和新英格兰、东中部、南大西洋、中西部以及山区和太平洋地区）。我们确定了五个地理区域费用差异的驱动因素，并使用风险调整模型评估每家医院费用的合理性。
在所有地区，男性、住院时间延长和并发症的发生都与费用增加始终相关。此外，中大西洋和新英格兰地区的费用显著较低。高于预期的费用与医院之间的病例组合指数相关性不佳（p = 0.289），但低于预期的费用在高容量医院更为常见。高容量医院的平均住院时间最短，这可能是中大西洋和新英格兰地区费用较低的原因；然而，即使调整了住院时间，所有地区医院的费用超支情况仍然差异很大。
费用差异可能源于患者相关因素以及医院之间与手术量相关的实践模式差异。对于在癌症中心寻求经济实惠治疗的患者而言，仍需要更标准的护理和收费透明度。
