在一份全州出院登记册中，肺叶切除术的手术方式和资源利用因解剖学肺叶而异。
Lung lobectomy surgical approach and resource utilization differ by anatomic lobe in a statewide discharge registry.
作者信息
DeArmond Daniel T, Rahman Mohammed S, Miller Stewart R, Jacobsen Christian P, Johnson Scott B, Nguyen Duy C, Das Nitin A
机构信息
Department of Cardiothoracic Surgery, Division of Thoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Department of Accounting, Information Systems, and Finance, School of Business, Emporia State University, Emporia, KS, USA.
出版信息
J Thorac Dis. 2022 Aug;14(8):2791-2801. doi: 10.21037/jtd-21-1898.
BACKGROUND
Anatomic lobe-specific differences with respect to pulmonary lobectomy have been suggested in the thoracic surgery literature but hard data has been lacking in larger population studies in part due to coding systems that do not distinguish pulmonary lobectomy by anatomic lobe. International Classification of Diseases, Tenth Revision (ICD-10) procedure codes, adopted in the United States in 2015, may provide novel methodologic accessibility for pulmonary lobectomy studies as they classify lobectomy operations by specific anatomic lobe. We queried the Texas Inpatient Public Use Data File (TPUDF) ICD-10 codes for both open and endoscopic approach lobectomy with a specific view to differences based on anatomic lobes.
METHODS
Between fourth fiscal quarter (Q4) 2015 and Q4 2017, all pulmonary lobectomy operations performed in Texas state-licensed hospitals were identified by querying the TPUDF for ICD-10 procedure codes for pulmonary lobectomy as classified by anatomic lobe. Surgical approach, additional procedures and diagnosis codes, length of hospital stay (LOS), and discharge status were recorded with aggregate values undergoing statistical analysis.
RESULTS
Right and left upper versus lower lobe resections were more prevalent however minimally invasive surgery was less commonly performed for upper than right lower lobectomy. LOS, irrespective of surgical approach, was longer for upper versus lower lobe resection as was need for transfer to additional inpatient facilities. LOS was longer and need for additional surgical or procedural interventions days after the primary procedure of lobectomy was greater for right versus left upper lobe resection, suggesting some differential properties of the right versus left pleural space.
CONCLUSIONS
The marked clinical differences between anatomic lobes in the setting of pulmonary lobectomy observed in this study have the potential to translate to differences in expected hospital and health system costs and surgeon time-expenditure and experience premium that currently have no mechanism for their accounting. These findings highlight the value of ICD-10 coding for analysis of pulmonary lobectomy in administrative databases and suggest a possible path to more informed patient counseling and equitable hospital and surgeon reimbursement based on payment adjustment by anatomic lobe in pulmonary lobectomy operations.
背景
胸外科文献中已提出肺叶切除术在解剖学上存在叶特异性差异，但由于编码系统未按解剖叶区分肺叶切除术，大型人群研究中缺乏确凿数据。2015年在美国采用的国际疾病分类第十版（ICD - 10）程序编码，可能为肺叶切除术研究提供新的方法学途径，因为它们按特定解剖叶对肺叶切除手术进行分类。我们查询了德克萨斯州住院患者公共使用数据文件（TPUDF）中开放和内镜入路肺叶切除术的ICD - 10编码，特别关注基于解剖叶的差异。
方法
在2015年第四财季（Q4）至2017年Q4期间，通过查询TPUDF中按解剖叶分类的肺叶切除术的ICD - 10程序编码，确定在德克萨斯州持牌医院进行的所有肺叶切除手术。记录手术入路、附加手术和诊断编码、住院时间（LOS）以及出院状态，并对汇总值进行统计分析。
结果
右上叶和左上叶与下叶切除术更为常见，然而，与右下叶切除术相比，上叶的微创手术较少。无论手术入路如何，上叶切除术的住院时间比下叶切除术更长，转至其他住院设施的需求也更大。与左上叶切除术相比，右上叶切除术在肺叶切除主要手术后的住院时间更长，对额外手术或程序干预的需求更大，这表明左右胸膜腔存在一些差异特性。
结论
本研究中观察到的肺叶切除术中解剖叶之间明显的临床差异，有可能转化为预期的医院和卫生系统成本差异，以及外科医生的时间支出和经验溢价差异，而目前尚无机制对此进行核算。这些发现凸显了ICD - 10编码在行政数据库中分析肺叶切除术的价值，并提出了一条可能的途径，即通过根据肺叶切除手术中的解剖叶进行支付调整，为患者提供更明智的咨询，并实现公平的医院和外科医生报销。
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