Cardiothoracic and Vascular Surgeons, Austin, Texas.
Emory University School of Medicine, Atlanta, Georgia.
Ann Thorac Surg. 2021 Jun;111(6):1781-1790. doi: 10.1016/j.athoracsur.2020.08.073. Epub 2020 Nov 12.
Costs related to care of patients who undergo lobectomy for lung cancer may vary depending on patient, disease, and treating facility characteristics. We aimed to identify underlying case mix factors that contribute to variability of 90-day costs of lobectomy for early-stage lung cancer.
The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for lobectomy for clinical stage I lung cancer (2008-2013). Demographics, clinical outcomes, and 90-day episode-of-care costs across all care settings were analyzed for patients successfully linked to Medicare data. Hospital costs were estimated from charges using cost-to-charge ratios. Comprehensive regression models were created to identify impact of preoperative patient factors and hospital characteristics on costs, and to delineate additive costs due to perioperative outcomes and complications.
The mean 90-day cost for lobectomy was $45,080 ± $38,239. Variables associated with significant additive costs were age greater than or equal to 75 years, American Society of Anesthesiologists classification III or IV, forced expiratory volume in 1 second less than 80% predicted, body mass index less than 18.5 or greater than 35, current or past smoker, cerebrovascular disease, chronic kidney disease, impaired functional status, open thoracotomy, prolonged operative time, government hospitals, metropolitan setting, and geographic location. Patients with 1 or more postoperative complication resulted in an overall mean added cost of $27,259. Added costs increased with the number of complications; isolated recurrent laryngeal nerve paresis ($3,911) and respiratory failure ($35,011) were associated with the least and most additive cost, respectively.
Lobectomy is associated with substantial variability of episode-of-care costs. Variability is driven by patient demographic and clinical factors, hospital characteristics, and the occurrence and severity of complications.
肺癌患者行肺叶切除术相关的治疗费用可能因患者、疾病和治疗机构的特点而有所不同。我们旨在确定导致早期肺癌行肺叶切除术 90 天费用差异的潜在病例组合因素。
从胸外科医师学会普通胸外科数据库中查询了 2008 年至 2013 年期间接受 I 期肺癌肺叶切除术的患者。对所有治疗环境中成功链接到医疗保险数据的患者进行人口统计学、临床结果和 90 天治疗费用分析。使用成本与收费比率来估计医院费用。建立了综合回归模型，以确定术前患者因素和医院特征对成本的影响，并阐明围手术期结局和并发症导致的附加成本。
肺叶切除术的 90 天平均费用为 45080 美元±38239 美元。与显著附加费用相关的变量包括年龄≥75 岁、美国麻醉医师协会分类 III 或 IV 级、用力呼气量小于预计值的 80%、体重指数小于 18.5 或大于 35、当前或过去吸烟、脑血管疾病、慢性肾脏病、功能状态受损、开胸手术、手术时间延长、公立医院、大都市环境和地理位置。术后发生 1 种或多种并发症的患者，总平均附加费用为 27259 美元。附加费用随并发症数量的增加而增加；孤立性喉返神经麻痹（3911 美元）和呼吸衰竭（35011 美元）分别与最低和最高附加成本相关。
肺叶切除术与治疗费用的巨大差异有关。变异性是由患者的人口统计学和临床因素、医院特征以及并发症的发生和严重程度驱动的。
