颈椎前路和后路手术的成本分析比较
Cost analysis comparison between anterior and posterior cervical spine approaches.
作者信息
Chan Alvin Y, Himstead Alexander S, Choi Elliot H, Hsu Zachary, Kurtz Joshua S, Yang Chenyi, Lee Yu-Po, Bhatia Nitin N, Lefteris Chad T, Wilson William C, Hsu Frank P K, Oh Michael Y
机构信息
Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California.
Department of Neurosurgery, Medical Scientist Training Program, Case Western Reserve University, Cleveland, Ohio.
出版信息
Surg Neurol Int. 2022 Jul 15;13:300. doi: 10.25259/SNI_497_2022. eCollection 2022.
BACKGROUND
The costs of cervical spine surgery have steadily increased. We performed a 5-year propensity scoring-matched analysis of 276 patients undergoing anterior versus posterior cervical surgery at one institution.
METHODS
We performed propensity score matching on financial data from 276 patients undergoing 1-3 level anterior versus posterior cervical fusions for degenerative disease (2015-2019).
RESULTS
We found no significant difference between anterior versus posterior approaches for hospital costs ($42,529.63 vs. $45,110.52), net revenue ($40,877.25 vs. $34,036.01), or contribution margins ($14,230.19 vs. $6,312.54). Multivariate regression analysis showed variables significantly associated with the lower contribution margins included age (β = -392.3) and length of stay (LOS; β = -1151). Removing age/LOS from the analysis, contribution margins were significantly higher for the anterior versus posterior approach ($17,824.16 vs. $6,312.54, = 0.01).
CONCLUSION
Anterior cervical surgery produced higher contribution margins compared to posterior approaches, most likely because posterior surgery was typically performed in older patients requiring longer LOS.
背景
颈椎手术的费用一直在稳步增加。我们对一家机构中276例行前路与后路颈椎手术的患者进行了为期5年的倾向评分匹配分析。
方法
我们对2015年至2019年因退行性疾病接受1 - 3节段前路与后路颈椎融合术的276例患者的财务数据进行倾向评分匹配。
结果
我们发现前路与后路手术在医院成本（42,529.63美元对45,110.52美元）、净收入（40,877.25美元对34,036.01美元）或边际贡献（14,230.19美元对6,312.54美元）方面没有显著差异。多变量回归分析显示，与较低边际贡献显著相关的变量包括年龄（β = -392.3）和住院时间（LOS；β = -1151）。从分析中去除年龄/住院时间后，前路手术的边际贡献显著高于后路手术（17,824.16美元对6,312.54美元，P = 0.01）。
结论
与后路手术相比，前路颈椎手术产生了更高的边际贡献，最可能的原因是后路手术通常在需要更长住院时间的老年患者中进行。
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