Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, United States of America.
Department of Surgery, David Geffen School of Medicine, University of California, UCLA, Los Angeles, CA, United States of America.
PLoS One. 2024 Jun 14;19(6):e0303586. doi: 10.1371/journal.pone.0303586. eCollection 2024.
Literature regarding the impact of esophagectomy approach on hospitalizations costs and short-term outcomes is limited. Moreover, few have examined how institutional MIS experience affects costs. We thus examined utilization trends, costs, and short-term outcomes of open and minimally invasive (MIS) esophagectomy as well as assessing the relationship between institutional MIS volume and hospitalization costs.
All adults undergoing elective esophagectomy were identified from the 2016-2020 Nationwide Readmissions Database. Multiple regression models were used to assess approach with costs, in-hospital mortality, and major complications. Additionally, annual hospital MIS esophagectomy volume was modeled as a restricted cubic spline against costs. Institutions performing > 16 cases/year corresponding with the inflection point were categorized as high-volume hospitals (HVH). We subsequently examined the association of HVH status with costs, in-hospital mortality, and major complications in patients undergoing minimally invasive esophagectomy.
Of an estimated 29,116 patients meeting inclusion, 10,876 (37.4%) underwent MIS esophagectomy. MIS approaches were associated with $10,600 in increased incremental costs (95% CI 8,800-12,500), but lower odds of in-hospital mortality (AOR 0.76; 95% CI 0.61-0.96) or major complications (AOR 0.68; 95% CI 0.60, 0.77). Moreover, HVH status was associated with decreased adjusted costs, as well as lower odds of postoperative complications for patients undergoing MIS operations.
In this nationwide study, MIS esophagectomy was associated with increased hospitalization costs, but improved short-term outcomes. In MIS operations, cost differences were mitigated by volume, as HVH status was linked with decreased costs in the setting of decreased odds of complications. Centralization of care to HVH centers should be considered as MIS approaches are increasingly utilized.
有关食管切除术方法对住院费用和短期结果影响的文献有限。此外，很少有研究探讨机构 MIS 经验如何影响成本。因此，我们检查了开放和微创（MIS）食管切除术的使用趋势、成本和短期结果，并评估了机构 MIS 量与住院费用之间的关系。
从 2016-2020 年全国再入院数据库中确定所有接受择期食管切除术的成年人。使用多元回归模型评估方法与成本、住院死亡率和主要并发症的关系。此外，还对每年医院 MIS 食管切除术量作为成本的限制三次样条进行建模。每年进行 > 16 例手术/年（对应拐点）的机构被归类为高容量医院（HVH）。随后，我们检查了 HVH 状态与微创食管切除术患者的成本、住院死亡率和主要并发症的关联。
在估计的 29116 名符合纳入标准的患者中，有 10876 名（37.4%）接受了 MIS 食管切除术。MIS 方法与增加的增量成本（95%CI 8800-12500）增加了 10600 美元，但住院死亡率（AOR 0.76；95%CI 0.61-0.96）或主要并发症（AOR 0.68；95%CI 0.60，0.77）的几率较低。此外，HVH 状态与调整后的成本降低以及接受 MIS 手术的患者术后并发症的几率降低相关。
在这项全国性研究中，MIS 食管切除术与住院费用增加有关，但短期结果改善。在 MIS 手术中，由于 HVH 状态与并发症几率降低相关，因此随着体积的增加，成本差异得到缓解。应考虑将护理集中到 HVH 中心，因为 MIS 方法的应用越来越广泛。
