Chughtai Bilal, Scherr Douglas, Del Pizzo Joseph, Herman Michael, Barbieri Christopher, Mao Jialin, Isaacs Abby, Lee Richard, Te Alexis E, Kaplan Steven A, Schlegel Peter, Sedrakyan Art
Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
Department of Public Health, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York.
Urol Pract. 2015 Mar;2(2):49-54. doi: 10.1016/j.urpr.2014.09.002. Epub 2014 Dec 20.
We determine national trends in costs of care as well as associated growth and adoption of minimally invasive surgery for major uro-oncology procedures.
Using a nationally representative sample we identified patients diagnosed with prostate, renal and bladder cancer who underwent prostatectomy, nephrectomy, partial nephrectomy and cystectomy from 2000 to 2011. Temporal trends in patient demographics, hospital and procedure related characteristics, surgical volume, minimally invasive surgery use and costs of hospitalization over the years were analyzed. Hierarchical linear regression was performed to evaluate the effects of hospital volume, time and surgery type on costs of hospitalization.
Overall 836,563, 440,337 and 122,992 patients underwent prostatectomy, nephrectomy and cystectomy from 2000 to 2011, respectively. There was a 33.6%, 50.8% and 25.5% increase in annual surgical volume for these 3 surgeries during the 10 years, with the most prominent increase at high volume hospitals. The use of minimally invasive surgery increased 65.6% for prostatectomy, 22.0% for nephrectomy and 12.5% for cystectomy, and this increase was more prominent at high volume hospitals. For all 3 surgeries the hospital stay for minimally invasive surgery cases was more expensive than for open procedures, but decreased during the study period from $17,367 to $11,145 for prostatectomy and from $54,209 to $28,753 for cystectomy.
High volume hospitals experienced greater growth in surgery caseloads and minimally invasive surgeries but this did not lead to higher costs of care. While minimally invasive surgery has consistently been more expensive than open surgery, the costs of minimally invasive prostatectomy and cystectomy have decreased in the last decade.
我们确定了护理成本的全国趋势，以及主要泌尿肿瘤手术中微创手术的相关增长和采用情况。
我们使用具有全国代表性的样本，确定了2000年至2011年期间接受前列腺切除术、肾切除术、部分肾切除术和膀胱切除术的前列腺癌、肾癌和膀胱癌患者。分析了这些年来患者人口统计学、医院和手术相关特征、手术量、微创手术使用情况和住院成本的时间趋势。进行分层线性回归以评估医院手术量、时间和手术类型对住院成本的影响。
2000年至2011年期间，分别有836,563、440,337和122,992例患者接受了前列腺切除术、肾切除术和膀胱切除术。在这10年中，这3种手术的年手术量分别增加了33.6%、50.8%和25.5%，在高手术量医院增加最为显著。前列腺切除术的微创手术使用率增加了65.6%，肾切除术增加了22.0%，膀胱切除术增加了12.5%，这种增加在高手术量医院更为显著。对于所有3种手术，微创手术病例的住院费用均高于开放手术，但在研究期间，前列腺切除术的住院费用从17,367美元降至11,145美元，膀胱切除术从54,209美元降至28,753美元。
高手术量医院的手术病例数和微创手术量增长更大，但这并未导致护理成本升高。虽然微创手术一直比开放手术成本更高，但在过去十年中，微创前列腺切除术和膀胱切除术的成本有所下降。
