Dietz Nicholas, Sharma Mayur, John Kevin, Wang Dengzhi, Ugiliweneza Beatrice, Mokshagundam Sriprakash, Bjurström Martin F, Boakye Maxwell, Williams Brian J, Andaluz Norberto
Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States.
Department of Endocrinology, University of Louisville, Louisville, Kentucky, United States.
J Neurol Surg B Skull Base. 2021 Dec 16;83(5):515-525. doi: 10.1055/s-0041-1740395. eCollection 2022 Oct.
Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown. This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection. This study is presented as a retrospective cohort analysis (2000-2016) with 2 years of follow-up. The study included national inpatient hospitalization and outpatient visits. Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC). This study investigated transphenoidal or subfrontal approach for tumor resection. Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study. Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; < 0.0001). ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.
捆绑支付和医疗保健利用模式为成本优化和手术结果提供了依据。颅咽管瘤切除术支付计划的经济分析尚不清楚。 本研究旨在确定内分泌和非内分泌并发症（分别为EC和NEC）对颅咽管瘤切除术后医疗保健利用和捆绑支付的影响。 本研究采用回顾性队列分析（2000 - 2016年），随访2年。 该研究纳入了全国住院患者住院情况和门诊就诊情况。 接受颅咽管瘤切除术的患者被分为以下四组：第1组，无并发症（NC）；第2组，仅EC；第3组，NEC；第4组，内分泌和非内分泌并发症均有（ENEC）。 本研究调查了经蝶窦或额下入路进行肿瘤切除。 住院再入院情况、出院后24个月内的医疗保健利用情况以及90天捆绑支付表现是本研究的主要结果。 与EC组（32,847美元）、NEC组（36,259美元）和ENEC组（32,596美元； < 0.0001）相比，NC队列患者的中位首次住院支付显著更低（28,672美元）。ENEC组患者在6个月（NC：38,268美元；EC：49,844美元；NEC：68,237美元；ENEC：81,053美元）、1年（NC：46,878美元；EC：58,210美元；NEC：81,043美元；ENEC：94,768美元）和2年（NC：58,391美元；EC：70,418美元；NEC：98,838美元；ENEC：111,841美元； < 0.0001）时产生的门诊服务费用和总体中位支付更高。90天中位捆绑支付在各队列之间存在显著差异，ENEC组最高（60,728美元），NC组最低（33,089美元； < 0.0001）。 手术后出现ENEC的患者在90天、6个月、1年和2年时的总体中位支付几乎是无并发症患者的两倍。捆绑支付模式在该患者群体中可能不是一个可行的选择。应考虑并发症类型和再入院率，以优化颅咽管瘤切除术后的支付模式预测。
