Verma Arjun, Hadaya Joseph, Richardson Shannon, Vadlakonda Amulya, Ramezani Ramin, Revels Sha'Shonda, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Computer Science, University of California, Los Angeles, Los Angeles, CA.
Ann Surg. 2023 Aug 1;278(2):e377-e381. doi: 10.1097/SLA.0000000000005699. Epub 2022 Sep 8.
To characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs.
The high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking.
Adults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions.
An estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62, P <0.001), as well as significantly reduced length of stay (-0.8 d, P <0.001) and costs (-$3900, P <0.001).
Increasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.
描述机构机器人辅助肺叶切除术的例数与住院费用之间的关系。
机器人辅助胸腔镜手术（RATS）的高成本是未采用该技术的医疗机构犹豫不决的几个原因之一。缺乏关于机构经验对RATS肺叶切除术成本影响的研究。
从2016年至2018年全国再入院数据库中识别出接受RATS肺叶切除术治疗原发性肺癌的成年人。开发了一个多变量回归模型来模拟住院费用，其中将医院RATS肺叶切除术例数作为受限立方样条纳入。样条拐点对应的例数用于将医院分为高例数（HVH）或低例数（LVH）。随后，我们研究了HVH状态与不良事件、住院时间、费用以及30天非选择性再入院之间的关联。
在研究期间，估计有14,756例患者接受了RATS肺叶切除术，中位费用为23,000美元。在对患者和手术特征进行调整后，医院RATS例数与费用呈负相关。虽然只有17.2%的中心被定义为HVH，但这些中心管理了51.7%的患者。HVH和LVH的患者在年龄、性别和合并症分布方面相似。值得注意的是，HVH的患者发生不良事件的风险调整后几率降低（调整优势比：0.62，P<0.001），住院时间也显著缩短（-0.8天，P<0.001），费用降低（-3900美元，P<0.001）。
医院RATS肺叶切除术例数的增加与住院费用的降低相关。我们的研究结果表明，高例数中心存在简化的护理路径，这会影响护理成本。
