Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
World J Surg. 2024 May;48(5):1096-1101. doi: 10.1002/wjs.12115. Epub 2024 Mar 8.
Studies show that reducing the length of hospital stay (LOS) for surgical patients leads to cost savings. We hypothesize that LOS has a nonlinear relationship to cost of care and reduction may not have a meaningful impact on it. We have attempted to define the relationship of LOS to cost of care. We utilized the itemized bill, generated in real time, for hospital services.
Adult patients admitted under General, Neuro, and Orthopedic surgery over a 3-month period, with an LOS between 4 and 14 days, were the study population. Itemized bill details were analyzed. Charges in Pakistani rupees were converted to US dollar. Ethical exemption for study was obtained.
Of the 853 patients, 38% were admitted to General Surgery, 27% to Neurosurgery, and 35% to Orthopedics. A total of 64% of the patients had an LOS between 4 and 6 days; 36% had an LOS between 7 and 14 days. Operated and conservatively managed constituted 82% and 18%, respectively. Mean total charge for operated patients was higher $3387 versus $1347 for non-operated ones. LOS was seen to have a nonlinear relationship to in-hospital cost of care. The bulk of cost was centered on the day of surgery. This was consistent across all services. The last day of stay contributed 2.4%-3.2% of total charge.
For surgical patients, the cost implications rapidly taper in the postoperative period. The contribution of the last day of stay cost to total cost is small. For meaningful cost containment, focus needs to be on the immediate perioperative period.
研究表明，减少外科患者的住院时间（LOS）可节省成本。我们假设 LOS 与护理成本之间存在非线性关系，减少 LOS 可能不会对其产生有意义的影响。我们试图定义 LOS 与护理成本之间的关系。我们使用实时生成的医院服务分项账单来进行分析。
本研究的对象为在普外科、神经外科和骨科接受治疗、住院时间为 4 至 14 天的成年患者。对分项账单的详细信息进行了分析。将巴基斯坦卢比的费用转换为美元。本研究已获得伦理豁免。
在 853 名患者中，38%的患者被收入普外科，27%的患者被收入神经外科，35%的患者被收入骨科。共有 64%的患者的 LOS 为 4 至 6 天；36%的患者 LOS 为 7 至 14 天。手术治疗和保守治疗分别占 82%和 18%。手术患者的平均总费用为 3387 美元，而非手术患者的平均总费用为 1347 美元。LOS 与住院期间的护理成本之间呈非线性关系。大部分费用集中在手术当天。这在所有科室中都是一致的。最后一天的住院费用占总费用的 2.4%至 3.2%。
对于外科患者，术后成本的影响迅速减少。最后一天住院费用对总费用的贡献很小。为了实现有意义的成本控制，需要关注围手术期。
