David Geffen School of Medicine at University of California, Los Angeles, (UCLA), Los Angeles, CA; Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: https://twitter.com/NguyenKLe18.
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Surgery. 2024 Sep;176(3):866-872. doi: 10.1016/j.surg.2024.05.038. Epub 2024 Jul 5.
Pancreaticoduodenectomy is a highly morbid operation with significant resource utilization. Using a national cohort, we examined the interhospital variation in pancreaticoduodenectomy hospitalization cost in the United States.
Adults undergoing elective pancreaticoduodenectomy in the setting of pancreatic cancer were tabulated from the 2016-2020 Nationwide Readmissions Database. A 2-level mixed-effects model was developed to evaluate the interhospital variation in pancreaticoduodenectomy hospitalization costs. Institutions within the top decile of risk-adjusted expenditures were defined as high-cost hospitals. Multivariable regression models were fitted to examine the association between high-cost hospital status and outcomes of interest. To account for the effects of complications on expenditures, a subgroup analysis comprising of patients with no adverse events was conducted.
The study included an estimated 24,779 patients with a median hospitalization cost of $38,800. After mixed-effects modeling, 40.9% of the cost variation was attributable to hospital, rather than patient, factors. Multivariable regression models revealed an association between high-cost hospital status and greater odds of complications and longer length of stay. Among patients without an adverse event, interhospital cost variation remained significant at 61.0%, and treatment at high-cost hospitals was similarly linked to longer length of stay.
Our study identified significant interhospital variation in pancreaticoduodenectomy hospitalization costs in the United States. Although high-cost hospital status was associated with increased odds of complications, variation remained significant even among patients without an adverse event. These results suggest the important role of hospital practices as contributors to expenditures. Further efforts to identify drivers of costs and standardize pancreatic surgical care are warranted.
胰十二指肠切除术是一种高度病态的手术，需要大量的资源利用。本研究利用全国性队列，在美国检查了胰十二指肠切除术住院费用的医院间差异。
从 2016 年至 2020 年全国再入院数据库中，列出了在胰腺癌环境下接受择期胰十二指肠切除术的成年人。采用两级混合效应模型评估胰十二指肠切除术住院费用的医院间差异。将风险调整支出排名前十分之一的机构定义为高成本医院。拟合多变量回归模型，以检查高成本医院状态与感兴趣的结果之间的关联。为了考虑并发症对支出的影响，进行了一个亚组分析，其中包括没有不良事件的患者。
本研究共纳入了估计 24779 名患者，中位住院费用为 38800 美元。经过混合效应模型分析，40.9%的费用变化归因于医院而不是患者因素。多变量回归模型显示，高成本医院状态与并发症发生率增加和住院时间延长有关。在没有不良事件的患者中，医院间的成本差异仍然显著，为 61.0%，在高成本医院治疗与住院时间延长也有类似的关联。
我们的研究在美国发现了胰十二指肠切除术住院费用的显著医院间差异。尽管高成本医院状态与并发症发生率增加有关，但即使在没有不良事件的患者中，差异仍然显著。这些结果表明，医院实践是导致支出的重要因素。需要进一步努力确定成本驱动因素并规范胰腺外科护理。
