Sun Helen H, Prunty Megan, Isali Ilaha, Mahran Amr, Ginsburg Kevin, Markt Sarah, Ponsky Lee, Calaway Adam, Bukavina Laura
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH, USA.
Bladder Cancer. 2021 Dec 13;7(4):439-447. doi: 10.3233/BLC-211580. eCollection 2021.
Many variables may affect the cost of open radical cystectomy (RC) care, including surgical approach, diversion type, patient comorbidities, and postoperative complications.
To determine factors associated with changes in cost of care following open radical cystectomy (ORC) for bladder cancer using the National Inpatient Sample (NIS).
Patients in the NIS with a diagnosis of bladder cancer who underwent ORC with ileal conduit from 2012-2017 using ICD-9-CM and ICD-10-CM codes were identified. Baseline demographics including age, race, region, postoperative complications, and length of stay were obtained. Univariable and multivariable logistic regression were used to identify factors associated with cost variation including demographics, clinical characteristics, surgical factors, and discharge quarter (Q1-Q4).
5,189 patients were included in the analysis, with 4,379 at urban teaching hospitals. On multivariable regression analysis, female sex [$1,734 ($1,024-2,444) < 0.001)], a greater Elixhauser comorbidity score [$93 ($62-124), < 0.001], presence of any inpatient complication [$1,531 ($894-2,168), < 0.001], and greater length of stay [$1,665 ($1,536-1,793), < 0.001] were associated with a greater cost of hospitalization. Discharge in Q3 (July to September) relative to Q2 (April to June) was associated with a higher cost [$1,113 ($292-1,933), = 0.008. Trends were similar at urban non-teaching and rural hospitals, except discharge quarter was not associated with a significant change in cost.
Significant differences in cost of ORC with ileal conduit exist with respect to patient sex, medical comorbidities, and discharge timing. These differences may relate to greater disease burden in female patients, patient complexity, and variation in postoperative care in academic programs.
许多因素可能影响开放性根治性膀胱切除术（RC）的护理成本，包括手术方式、尿流改道类型、患者合并症及术后并发症。
利用国家住院患者样本（NIS）确定与膀胱癌开放性根治性膀胱切除术（ORC）后护理成本变化相关的因素。
通过国际疾病分类第九版临床修订本（ICD-9-CM）和国际疾病分类第十版临床修订本（ICD-10-CM）编码，在NIS中识别出2012年至2017年接受ORC并采用回肠代膀胱术的膀胱癌患者。获取包括年龄、种族、地区、术后并发症及住院时间等基线人口统计学数据。采用单变量和多变量逻辑回归分析确定与成本变化相关的因素，包括人口统计学、临床特征、手术因素及出院季度（第1季度至第4季度）。
5189例患者纳入分析，其中4379例在城市教学医院。多变量回归分析显示，女性[$1734（$1024 - 2444），<0.001]、埃利克斯豪泽合并症评分更高[$93（$62 - 124），<0.001]以及存在任何住院并发症[$1531（$894 - 2168），<0.001]和住院时间更长[$1665（$1536 - 1793），<0.001]与更高的住院成本相关。相对于第2季度（4月至6月），第3季度（7月至9月）出院与更高的成本相关[$1113（$292 - 1933），=0.0
