University Hospitals Leuven, Leuven, Belgium.
KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium.
Spine (Phila Pa 1976). 2020 Sep 1;45(17):1221-1228. doi: 10.1097/BRS.0000000000003497.
Retrospective, single-center analysis.
To calculate the total clinical hospital cost of the Adult Spinal Deformity (ASD) care trajectory, to explain cost variability by patient and surgery characteristics, and to identify areas of process improvement opportunities.
ASD is associated with a high financial and clinical burden on society. ASD care thus requires improved insights in costs and its drivers as a critical step toward the improvement of value, i.e., the ratio between delivered health outcome and associated costs.
Patient characteristics and surgical variables were collected following ethical approval in a cohort of 139 ASD patients, treated between December, 2014 and January, 2018. Clinical hospital costs were calculated, including all care activities, from initial consultation to 1 year after initial surgery (excl. overhead) in a university hospital setting. Multiple linear regression analysis was performed to analyze the impact of patient and surgical characteristics on clinical costs.
75.5% of the total clinical hospital cost (&OV0556;27,865) was incurred during initial surgery with costs related to the operating theatre (80.3%), nursing units (11.9%), and intensive care (2.9%) being the largest contributors. 57.5% of the variation in total cost could be explained in order of importance by surgical invasiveness, age, coronary disease, single or multiple-staged surgery, and mobility status. Revision surgery, unplanned surgery due to complications, was found to increase average costs by 87.6% compared with elective surgeries (&OV0556; 44,907 (± &OV0556; 23,429) vs. &OV0556; 23,944 (± &OV0556; 7302)).
This study identified opportunities for process improvement by calculating the total clinical hospital costs. In addition, it identified patient and treatment characteristics that predict 57.5% of cost variation, which could be taken into account when developing a payment system. Future research should include outcome data to assess variation in value.
回顾性、单中心分析。
计算成人脊柱畸形（ASD）治疗轨迹的总临床医院成本，解释患者和手术特征对成本的影响，并确定改进流程的机会领域。
ASD 给社会带来了很高的经济和临床负担。因此，ASD 护理需要更好地了解成本及其驱动因素，这是提高价值的关键步骤，即所提供的健康结果与相关成本之间的比率。
在 2014 年 12 月至 2018 年 1 月期间，对 139 名 ASD 患者进行了一项队列研究，经伦理批准后收集了患者特征和手术变量。在大学医院环境中，从初始咨询到初始手术后 1 年（不包括间接费用），计算了所有医疗活动的临床医院成本。采用多元线性回归分析，分析患者和手术特征对临床成本的影响。
75.5%的总临床医院成本（&OV0556;27865）发生在初次手术期间，手术室（80.3%）、护理单元（11.9%）和重症监护（2.9%）的费用是最大的贡献者。重要性依次为手术侵袭性、年龄、冠心病、单阶段或多阶段手术以及活动能力，可解释总成本变异的 57.5%。与择期手术相比，因并发症而进行的翻修手术和非计划手术使平均成本增加了 87.6%（&OV0556;44907（±&OV0556;23429）vs. &OV0556;23944（±&OV0556;7302））。
本研究通过计算总临床医院成本，确定了改进流程的机会。此外，还确定了可预测成本变异 57.5%的患者和治疗特征，在制定支付系统时可以考虑这些特征。未来的研究应包括结果数据，以评估价值的变化。
4 级。
