当日手术与过夜住院在甲状腺全切除术中的应用和成本：一项多州、全付费者分析。
The use and costs of same-day surgery versus overnight admission for total thyroidectomy: A multi-state, all-payer analysis.
机构信息
Department of Surgery, Weill Cornell Medicine, New York, NY; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
出版信息
Surgery. 2024 Jan;175(1):207-214. doi: 10.1016/j.surg.2023.06.051. Epub 2023 Nov 20.
BACKGROUND
Outpatient thyroidectomy is increasingly favored, given evidence of safety and convenience for selected patients. However, the prevalence of same-day discharge is unclear. We aimed to evaluate temporal trends, hospital characteristics, and costs associated with same-day discharge after total thyroidectomy in an all-payer, multi-state cohort.
METHODS
We included patients aged ≥18 years who underwent a total thyroidectomy (2013-2019) using Healthcare Cost and Utilization Project data. Admission type was defined as same-day, overnight, or inpatient based on length of stay. Same-day patients were propensity-score matched 1:1 with overnight patients. Hospital characteristics and costs were compared in the matched cohort.
RESULTS
Among 86,187 patients who underwent total thyroidectomy, 16,743 (19.4%) cases were same-day, 59,778 (69.4%) were overnight, and 9,666 (11.2%) were inpatient. The proportion of patients who underwent same-day thyroidectomy increased from 14.8% to 20.8% over the study period (P < .001), whereas overnight admissions decreased from 72.9% to 68.8% (P < .001). In total, 9,571 same-day patients were matched to 9,571 overnight patients. Same-day patients had higher odds of treatment at a certified cancer center (odds ratio 1.77; 95% confidence interval 1.65-1.90), Accreditation Council for Graduate Medical Education-accredited teaching hospital (odds ratio 1.72; 95% confidence interval 1.61-1.85), and high-volume hospital (odds ratio 1.53; 95% confidence interval 1.42-1.65). Pairwise cost differences showed median savings of $974 (interquartile range -1,610 to 3,491) for same-day relative to overnight admission (P < .001).
CONCLUSION
Although over two-thirds of patients are admitted overnight, same-day total thyroidectomy is increasingly performed. Same-day thyroidectomy may be a lower-cost option for selected patients, particularly in specialty centers with experience in thyroidectomy.
背景
鉴于某些患者安全性和便利性的证据，门诊甲状腺切除术越来越受到青睐。然而，当天出院的比例尚不清楚。我们旨在评估全甲状腺切除术患者当天出院的时间趋势、医院特征和费用，该研究使用了一个多州的支付者所有数据。
方法
我们纳入了年龄≥18 岁，2013-2019 年使用医疗保健成本和利用项目数据接受全甲状腺切除术的患者。根据住院时间，入院类型定义为当天、过夜或住院。当天出院的患者与过夜患者进行了倾向评分匹配 1:1。在匹配的队列中比较了医院特征和费用。
结果
在 86187 例接受全甲状腺切除术的患者中，16743 例（19.4%）为当天出院，59778 例（69.4%）为过夜，9666 例（11.2%）为住院。在研究期间，当天进行甲状腺切除术的患者比例从 14.8%增加到 20.8%（P<.001），而过夜入院的比例从 72.9%下降到 68.8%（P<.001）。共有 9571 例当天出院的患者与 9571 例过夜的患者相匹配。当天出院的患者在认证癌症中心（优势比 1.77；95%置信区间 1.65-1.90）、研究生医学教育认证教学医院（优势比 1.72；95%置信区间 1.61-1.85）和高容量医院（优势比 1.53；95%置信区间 1.42-1.65）接受治疗的可能性更高。成对成本差异显示，与过夜相比，当天出院的中位数节省 974 美元（四分位距 -1610 至 3491）（P<.001）。
结论
尽管超过三分之二的患者过夜住院，但当天出院的全甲状腺切除术越来越多。对于选定的患者，当天出院的甲状腺切除术可能是一种成本较低的选择，特别是在有甲状腺切除术经验的专科中心。
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