Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, SE-171 77, Stockholm, Sweden.
Department of Gynecology & Obstetrics, Karolinska Institutet, Danderyd University Hospital, Danderyd, 182 88, Stockholm, Sweden.
Int Urogynecol J. 2021 Nov;32(11):3007-3015. doi: 10.1007/s00192-021-04698-x. Epub 2021 Feb 26.
The aim of this study was to evaluate whether high surgical volume at a single center was associated with lower healthcare costs compared to lower surgical volume in a multicenter setting.
All patients had symptomatic and anatomical apical prolapse (POP-Q ≥ stage II) with or without cystocele and were operated on by a standard surgical procedure using the Uphold mesh. Data on time of resource use in terms of surgery time, hospital stay and re-interventions across 5 years were compared between the single center (97 patients) and multicenter (173 patients, at 24 clinics). Unit costs for surgical time, inpatient and outpatient visits were extracted from the single-center hospital's operation analysis program and prime production cost. Total costs were estimated for primary surgery and during 5-year follow-up.
Costs for primary surgery were comparable between the single and the multicenter ($13,561 ± 2688 and $13,867 ± 1177, P = 0.29). Follow-up costs 5 years after primary surgery were 2.8 times higher at the multicenter than single center ($3262 vs. $1149, P < 0.001). Mean cost per patient over 5 years was significantly lower at the single than multicenter [$14,710 (CI: 14,168-15,252) vs. $17,128 (CI: 16,952-17,305), P < 0.001)].
Using a mesh kit for apical pelvic organ prolapse in a high surgical volume center was associated with reduced healthcare costs compared with a lower volume multiple-site setting. The cost reduction at the high surgical volume center increased over time because of lower surgical and medical re-intervention rates for postoperative complications and recurrence.
本研究旨在评估在多中心环境中与低手术量相比，单一中心的高手术量是否与降低医疗保健成本相关。
所有患者均患有症状性和解剖性 apical prolapse（POP-Q≥2 期），伴有或不伴有膀胱膨出，并通过使用 Uphold 网片的标准手术程序进行手术。比较了单中心（97 例患者）和多中心（24 个诊所的 173 例患者）在 5 年内手术时间、住院时间和再干预方面的资源使用时间数据。手术时间、门诊和住院就诊的单位成本从单中心医院的手术分析程序和主要生产成本中提取。估计了主要手术和 5 年随访期间的总成本。
单中心和多中心的初次手术费用相当（$13561±2688 和 $13867±1177，P=0.29）。初次手术后 5 年的随访费用在多中心是单中心的 2.8 倍（$3262 比 $1149，P<0.001）。5 年内每位患者的平均成本在单中心显著低于多中心 [$14710（CI：14168-15252）比 $17128（CI：16952-17305），P<0.001]。
在高手术量中心使用网片套件治疗 apical pelvic organ prolapse 与在低手术量多中心环境相比，可降低医疗保健成本。由于术后并发症和复发的手术和医疗再干预率较低，高手术量中心的成本降低随着时间的推移而增加。
