在没有日间手术中心的学术医疗中心实施门诊微创腰椎减压术：成本分析和系统评价。
Implementation of Outpatient Minimally Invasive Lumbar Decompression at an Academic Medical Center without Ambulatory Surgery Centers: A Cost Analysis and Systematic Review.
机构信息
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Adult Business Line Finance, University of California Medical Center, San Francisco, California, USA.
出版信息
World Neurosurg. 2021 Feb;146:e961-e971. doi: 10.1016/j.wneu.2020.11.044. Epub 2020 Nov 26.
BACKGROUND
Lumbar decompressions are increasingly performed at ambulatory surgery centers (ASCs). We sought to compare costs of open and minimally invasive (MIS) lumbar decompressions performed at a university without dedicated ASCs.
METHODS
Lumbar decompressions performed at a tertiary academic hospital or satellite university hospital dedicated to outpatient surgery were retrospectively reviewed. Care pathways were same-day, overnight observation, or inpatient admission. Patient demographics, American Society of Anesthesiologists classification, Charlson Comorbidity Index, surgical characteristics, 30-day readmission, and costs were collected. A systematic review of lumbar decompression cost literature was performed.
RESULTS
A total of 354 patients, mean age 55 years with 128 women (36.2%), were reviewed. There was no significant difference in age, gender, body mass index, American Society of Anesthesiologists classification, or Charlson Comorbidity Index between patients treated with open and minimally invasive surgery. Open decompression was associated with higher total cost ($21,280 vs. $14,407; P < 0.001); however, this was driven by care pathway and length of stay. When stratifying by care pathway, there was no difference in total cost between open versus minimally invasive surgery among same-day ($10,609 vs. $11,074; P = 0.556), overnight observation ($14,097 vs. $13,992; P = 0.918), or inpatient admissions ($24,507 vs. $27,929; P = 0.311).
CONCLUSIONS
When accounting for care pathway, the cost of open and MIS decompression were no different. Transition from a tertiary academic hospital to a university hospital specializing in outpatient surgery was not associated with lower costs. Academic departments may consider transitioning lumbar decompressions to a dedicated ASC to maximize cost savings; however, additional studies are needed.
背景
腰椎减压术在日间手术中心（ASC）中越来越普遍。我们旨在比较在没有专门 ASC 的大学进行的开放式和微创（MIS）腰椎减压术的成本。
方法
回顾性审查了在三级学术医院或专门进行门诊手术的卫星大学医院进行的腰椎减压术。治疗途径为当天出院、过夜观察或住院。收集了患者人口统计学、美国麻醉医师协会分类、Charlson 合并症指数、手术特点、30 天再入院和成本。对腰椎减压成本文献进行了系统回顾。
结果
共审查了 354 例患者，平均年龄 55 岁，女性 128 例（36.2%）。接受开放式和微创手术治疗的患者在年龄、性别、体重指数、美国麻醉医师协会分类或 Charlson 合并症指数方面无显著差异。开放式减压与更高的总费用相关（$21280 与 $14407；P<0.001）；然而，这是由治疗途径和住院时间驱动的。当按治疗途径分层时，在当天出院（$10609 与 $11074；P=0.556）、过夜观察（$14097 与 $13992；P=0.918）或住院治疗（$24507 与 $27929；P=0.311）中，开放式与微创手术之间的总费用无差异。
结论
在考虑治疗途径的情况下，开放式和 MIS 减压的成本没有差异。从三级学术医院过渡到专门从事门诊手术的大学医院并没有降低成本。学术部门可能会考虑将腰椎减压术转移到专门的 ASC 以最大限度地节省成本；然而，还需要进一步的研究。
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