门诊手术中心与医院门诊部门治疗骨科手术的比较。
Ambulatory Surgery Centers Versus Hospital Outpatient Departments for Orthopaedic Surgeries.
机构信息
From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Wang, Puvanesarajah, Marrache, Ficke and, Jain), and the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Levy).
出版信息
J Am Acad Orthop Surg. 2022 Mar 1;30(5):207-214. doi: 10.5435/JAAOS-D-21-00739.
BACKGROUND
The goals of this study were to compare the utilization and costs of ambulatory surgery centers (ASCs) versus hospital outpatient department (HOPD) for commonly performed outpatient orthopaedic surgical procedures.
METHODS
Commercially insured patients undergoing elective, outpatient orthopaedic surgery were queried using an administrative claims database. We queried the following surgeries: carpal tunnel release, lumbar microdiskectomy, anterior cruciate ligament reconstruction, knee arthroscopy, arthroscopic rotator cuff repair, and bunion repair. Total costs were defined as the sum of all payments for a surgical episode. Professional fees were defined as payments to the primary orthopaedic surgeon and technical fees as all other payments. Comparisons between ASC and HOPD reimbursements were conducted using bivariate statistics and generalized linear models controlling for patient age, sex, and Elixhauser comorbidity index.
RESULTS
Among 990,980 cases of outpatient orthopaedic surgery done from 2013 to 2018, the utilization rate of ASCs increased from 31% to 34% across all procedures assessed: compound annual growth rate of 3.3% for lumbar microdiscectomy, 1.8% for knee arthroscopy, 1.4% for anterior cruciate ligament, 1.4% for carpal tunnel release, 1.2% for arthroscopic rotator cuff repair, and 0.5% for bunion repair (P < 0.001 for all). The average total costs were 26% lower at ASCs than HOPDs (P < 0.001 for each procedure). The average technical fees were 33% lower at ASCs than HOPDs (P < 0.001 for each procedure). Both total costs and technical fees were less for ASCs than HOPDs after controlling for patient age, sex, and Elixhauser comorbidity index (P < 0.001 for each procedure). Over the study period, the mean total costs at HOPDs increased by 2.5% yearly, whereas the mean total costs at ASCs decreased by 0.1% yearly. The average surgeon professional fees declined in both care settings over time.
CONCLUSION
From 2013 to 2018, there was an increase in ASC utilization for common outpatient orthopaedic surgeries. ASCs were overall less costly than HOPDs for outpatient orthopaedic surgeries.
LEVEL OF EVIDENCE
IV.
背景
本研究的目的是比较门诊手术中心（ASC）和医院门诊（HOPD）在常见门诊骨科手术中的应用和成本。
方法
使用行政索赔数据库对接受择期门诊骨科手术的商业保险患者进行查询。我们查询了以下手术：腕管松解术、腰椎小关节切除术、前交叉韧带重建术、膝关节镜检查、关节镜下肩袖修复术和拇囊炎修复术。总费用定义为手术期间所有支付款项的总和。专业费用定义为支付给主要骨科医生的费用，技术费用定义为所有其他支付款项。使用双变量统计和广义线性模型，根据患者年龄、性别和 Elixhauser 合并症指数，对 ASC 和 HOPD 的报销情况进行比较。
结果
在 2013 年至 2018 年期间，对 990980 例门诊骨科手术进行了评估，所有评估的手术中 ASC 的使用率从 31%增加到 34%：腰椎小关节切除术的年复合增长率为 3.3%，膝关节镜检查为 1.8%，前交叉韧带为 1.4%，腕管松解术为 1.4%，关节镜下肩袖修复术为 1.2%，拇囊炎修复术为 0.5%（均<0.001）。ASC 的总费用平均比 HOPD 低 26%（各手术均<0.001）。ASC 的技术费用平均比 HOPD 低 33%（各手术均<0.001）。在控制患者年龄、性别和 Elixhauser 合并症指数后，ASC 的总费用和技术费用均低于 HOPD（各手术均<0.001）。在研究期间，HOPD 的平均总费用每年增长 2.5%，而 ASC 的平均总费用每年下降 0.1%。随着时间的推移，两种护理环境下的外科医生平均专业费用都有所下降。
结论
2013 年至 2018 年，常见门诊骨科手术中 ASC 的使用率有所增加。ASC 用于门诊骨科手术的总体成本低于 HOPD。
证据水平
IV。
Zotero 插件