Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
Financial Director, UofL Health-University Hospital, Louisville, KY, USA.
Am Surg. 2024 Sep;90(9):2149-2155. doi: 10.1177/00031348241244638. Epub 2024 Apr 4.
Video-assisted thoracoscopic surgery (VATS) is a practical resource in the management of traumatic hemothorax. However, it carries inherent risks and should be mobilized cost-effectively. In this study, we investigated the ideal VATS timing using cost analysis.
617 cases of unilateral traumatic hemothorax from 2012 to 2022 were identified in our trauma database. We extracted encounter cost, length of stay (LOS), and operative cost information. Using Kruskal-Walli's test, we compared the cost and LOS for patients who underwent VATS or continued nonoperative management in the first 7 days of admission. Additionally, we computed the daily proportion of patients initially managed nonoperatively but ultimately underwent VATS. -values <.05 were considered significant.
The median encounter cost of cases managed operatively before hospital day 4 (HD4) was higher than those managed nonoperatively. This difference was $63k on HD2 (-value .07) and was statistically significant for HD3 (difference of $65k, -value .02). The median LOS with operational management on HD2 and 3 was 7 and 6 respectively vs median LOS of 2 and 3 with nonoperative management on those days (-value <.001, .01 respectively). The proportion of patients who failed nonoperative management did not change from baseline until HD4 (23% (95% CI 19.7, 26.3) vs 33.9% (95% CI 28.3, 39.6), -value <.001).
Early mobilization of VATS before hospital day 4 increases the overall hospital cost without offering any length of stay benefit. Continuing nonoperative management longer than 4 days is associated with a high failure rate and a costlier operation.
电视辅助胸腔镜手术（VATS）是创伤性血胸管理的实用资源。然而，它具有内在风险，应该具有成本效益。在这项研究中，我们通过成本分析研究了理想的 VATS 时机。
从我们的创伤数据库中确定了 2012 年至 2022 年期间的 617 例单侧创伤性血胸病例。我们提取了就诊费用、住院时间（LOS）和手术费用信息。使用 Kruskal-Walli 检验，我们比较了在入院后第 7 天内接受 VATS 或继续非手术治疗的患者的成本和 LOS。此外，我们计算了最初接受非手术治疗但最终接受 VATS 治疗的患者的每日比例。-值<0.05 被认为具有统计学意义。
在入院后第 4 天（HD4）之前接受手术治疗的病例的中位数就诊费用高于非手术治疗的病例。这一差异在 HD2 为 63k 美元（-值为 0.07），在 HD3 为 65k 美元（-值为 0.02），具有统计学意义。HD2 和 3 接受手术治疗的中位 LOS 分别为 7 天和 6 天，而在这些天接受非手术治疗的中位 LOS 分别为 2 天和 3 天（-值<0.001，分别为 0.01）。从基线到 HD4，非手术治疗失败的患者比例没有变化（23%（95%CI 19.7，26.3）vs 33.9%（95%CI 28.3，39.6），-值<0.001）。
在入院后第 4 天之前早期动员 VATS 会增加整体住院费用，而不会带来任何住院时间的益处。将非手术治疗延长至 4 天以上与高失败率和成本更高的手术相关。
