术后并发症相关的医院成本：基于成本效益的并发症预防效果分析。
Hospital Costs Following Surgical Complications: A Value-driven Outcomes Analysis of Cost Savings Due to Complication Prevention.
机构信息
Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
出版信息
Ann Surg. 2022 Feb 1;275(2):e375-e381. doi: 10.1097/SLA.0000000000004243.
OBJECTIVE
Surgical complications have substantial impact on healthcare costs. We propose an analysis of the financial impact of postoperative complications.
SUMMARY OF BACKGROUND DATA
Both complications and preoperative patient risk have been shown to increase costs following surgery. The extent of cost increase due to specific complications has not been well described.
METHODS
A single institution's American College of Surgeons National Surgical Quality Improvement Program data was queried from 2012 to 2018 and merged with institutional cost data for each encounter. A mixed effects multivariable generalized linear model was used to estimate the mean relative increase in hospital cost due to each complication, adjusting for patient and procedure-level fixed effects clustered by procedure. Potential savings were calculated based on projected decreases in complication rates and theoretical hospital volume.
RESULTS
There were 11,897 patients linked between the 2 databases. The rate of any American College of Surgeons National Surgical Quality Improvement Program complication was 11.7%. The occurrence of any complication resulted in a 1.5-fold mean increase in direct hospital cost [95% confidence interval (CI) 1.49-1.58]. The top 6 most costly complications were postoperative septic shock (4.0-fold, 95% CI 3.58-4.43) renal insufficiency/failure (3.3-fold, 95% CI 2.91-3.65), any respiratory complication (3.1-fold, 95% CI 2.94-3.36), cardiac arrest (3.0-fold, 95% CI 2.64-3.46), myocardial infarction (2.9-fold, 95% CI 2.43-3.42) and mortality within 30 days (2.2-fold, 95% CI 2.01-2.48). Length of stay (6.5 versus 3.2 days, P < 0.01), readmission rate (29.1% vs 3.1%, P < 0.01), and discharge destination outside of home (20.5% vs 2.7%, P < 0.01) were significantly higher in the population who experienced complications.
CONCLUSIONS
Decreasing complication rates through preoperative optimization will improve patient outcomes and lead to substantial cost savings.
目的
手术并发症对医疗保健成本有重大影响。我们提出了对术后并发症经济影响的分析。
背景资料概要
并发症和术前患者风险已被证明会增加手术后的成本。特定并发症导致的成本增加程度尚未得到很好的描述。
方法
从 2012 年至 2018 年，对单机构美国外科医师学会国家外科质量改进计划（American College of Surgeons National Surgical Quality Improvement Program，ACS-NSQIP）数据进行查询，并与每次就诊的机构成本数据合并。使用混合效应多变量广义线性模型来估计由于每个并发症导致的医院成本的平均相对增加，同时调整按手术聚类的患者和手术水平固定效应。根据并发症发生率和理论医院容量的预计降低，计算潜在的节省。
结果
在这两个数据库之间有 11897 名患者被关联。ACS-NSQIP 并发症的发生率为 11.7%。任何并发症的发生导致直接医院成本平均增加 1.5 倍[95%置信区间（confidence interval，CI）为 1.49-1.58]。最昂贵的前 6 种并发症是术后感染性休克（4.0 倍，95%CI 为 3.58-4.43）、肾功能不全/衰竭（3.3 倍，95%CI 为 2.91-3.65）、任何呼吸并发症（3.1 倍，95%CI 为 2.94-3.36）、心脏骤停（3.0 倍，95%CI 为 2.64-3.46）、心肌梗死（2.9 倍，95%CI 为 2.43-3.42）和 30 天内死亡率（2.2 倍，95%CI 为 2.01-2.48）。经历并发症的患者的住院时间（6.5 天与 3.2 天，P < 0.01）、再入院率（29.1%与 3.1%，P < 0.01）和出院目的地不在家（20.5%与 2.7%，P < 0.01）显著更高。
结论
通过术前优化降低并发症发生率将改善患者结局并带来大量成本节省。
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