Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
J Gastrointest Surg. 2021 Jan;25(1):195-200. doi: 10.1007/s11605-020-04814-0. Epub 2020 Oct 9.
Physician variation in adherence to best practices contributes to the high costs of health care. Understanding surgeon-specific cost variation in common surgical procedures may inform strategies to improve the value of surgical care.
Laparoscopic cholecystectomies at a single institution were identified over a 5-year period and linked to an institutional cost database. Multiple linear regression was used to control for patient-, case-, and hospital-specific factors while assessing the impact of surgeon variability on cost.
The final dataset contained 1686 patients. Higher surgeon volume (reported in tertiles) was associated with decreased costs ($5354 vs. $6301 vs. $7156, p < 0.01) and OR times (66 min vs. 85 min vs. 95 min, p < 0.01). After controlling for patient-, case-, and hospital-specific factors, non-MIS fellowship training type (p < 0.01) and low surgeon volume (p < 0.01) were associated with increased costs, while time in practice did not contribute to cost variation (p = NS).
Surgeon variability contributes to costs in laparoscopic cholecystectomy. Some of this variability is associated with operative volume and fellowship training. Collaboration to limit this cost variability may reduce surgical resource utilization.
医生在遵守最佳实践方面的差异导致了医疗保健成本的高昂。了解常见手术中外科医生特定的成本差异可能有助于制定提高手术护理价值的策略。
在 5 年内确定了一家机构的腹腔镜胆囊切除术，并将其与机构成本数据库相关联。在评估外科医生变异性对成本的影响时，使用多元线性回归来控制患者、病例和医院的具体因素。
最终数据集包含 1686 名患者。较高的外科医生手术量（按三分位数报告）与降低的成本（$5354 与 $6301 与 $7156，p<0.01）和手术时间（66 分钟与 85 分钟与 95 分钟，p<0.01）相关。在控制患者、病例和医院的具体因素后，非微创外科医师协会培训类型（p<0.01）和低外科医生手术量（p<0.01）与成本增加相关，而从业时间的长短并未导致成本的差异（p=NS）。
外科医生的变异性导致腹腔镜胆囊切除术的成本增加。这种变异性的一部分与手术量和专科培训有关。协作以限制这种成本变异性可能会减少手术资源的利用。
