Lin Saunders, Dewey Elizabeth N, Tsikitis V Liana
From the Department of Surgery, Oregon Health and Science University, Portland, OR.
Ann Surg Open. 2021 Sep 3;2(3):e088. doi: 10.1097/AS9.0000000000000088. eCollection 2021 Sep.
To examine possible associations in inpatient healthcare expenditure and guideline changes in the surgical management of diverticulitis, in terms of both cost per discharge and total aggregate costs of care.
Medical costs throughout the healthcare system continue to rise due to increased prices for services, increased quantities of high-priced technologies, and an increase in the amount of overall services.
We used a retrospective case-control design using the Healthcare Cost and Utilization Project National Inpatient Sample to evaluate cost per discharge and total aggregate costs of diverticulitis management between 2004 and 2015. The year 2010 was selected as the transition between the pre and postguideline implementation period.
The sample consisted of 450,122 unweighted (2,227,765 weighted) inpatient discharges for diverticulitis. Before the implementation period, inpatient costs per discharge increased 1.13% in 2015 dollars (95% confidence intervals [CI] 0.76% to 1.49%) per quarter. In the postimplementation period, the costs per discharge decreased 0.27% (95% CI -0.39% to -0.15%) per quarter. In aggregate, costs of care for diverticulitis increased 0.61% (95% CI 0.28% to 0.95%) per quarter prior to the guideline change, and decreased 0.52% (95% CI -0.87% to -0.17) following the guideline change.
This is the first study to investigate any associations between evidence-based guidelines meant to decrease surgical utilization and inpatient healthcare costs. Decreased inpatient costs of diverticulitis management may be associated with guideline changes to reduce surgical intervention for diverticulitis, both in regards to cost per discharge and aggregate costs of care.
从每次出院费用和护理总费用两方面，研究憩室炎手术治疗中住院医疗费用与指南变化之间可能存在的关联。
由于服务价格上涨、高价技术使用量增加以及总体服务量增加，整个医疗系统的医疗成本持续上升。
我们采用回顾性病例对照设计，利用医疗成本和利用项目国家住院样本，评估2004年至2015年期间憩室炎治疗的每次出院费用和总费用。选择2010年作为指南实施前后的过渡期。
样本包括450,122例未加权（2,227,765例加权）的憩室炎住院出院病例。在实施期之前，以2015年美元计算，每次出院的住院费用每季度增加1.13%（95%置信区间[CI]0.76%至1.49%）。在实施期之后，每次出院费用每季度下降0.27%（95%CI -0.39%至-0.15%）。总体而言，在指南变更之前，憩室炎护理费用每季度增加0.61%（95%CI 0.28%至0.95%），在指南变更之后下降0.52%（95%CI -0.87%至-0.17%）。
这是第一项研究旨在减少手术利用率的循证指南与住院医疗费用之间关联的研究。憩室炎治疗住院费用的降低可能与旨在减少憩室炎手术干预的指南变化有关，无论是每次出院费用还是护理总费用。
