Lassiter Grace, Etchill Eric, Sholklapper Tamir, Chidiac Charbel, Canner Joseph, Rhee Daniel Sangkyu
Department of Anesthesia, Weil Cornell Medicine, New York, NY, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Chest Surg. 2025 Jan 5;58(1):34-43. doi: 10.5090/jcs.24.051. Epub 2024 Nov 18.
The optimal treatment for primary spontaneous pneumothorax (PSP) remains undefined. Furthermore, the overall utilization and costs of various treatment approaches are incompletely understood. We investigated hospital charges and resource utilization by management strategy across the state of Maryland in adult and pediatric patients with PSP.
We queried the Maryland Health Services Cost Review Commission database for patients aged 10-40 years admitted with PSP between 2012 and 2020. Patients managed with a chest tube alone (CT) were compared with recipients of video-assisted thoracoscopic surgery (VATS). Subsequently, we analyzed hospital charges for patients undergoing early VATS (<48 hours post-admission) vs. delayed VATS (≥48 hours). The predicted incremental cost of early vs. delayed VATS was calculated.
Overall, 354 admissions were identified, with 211 (59.6%) receiving CT management and 143 (40.4%) undergoing VATS. Patients receiving VATS were more likely to be female (24% vs. 15%, p=0.030) and Black (32% vs. 20%, p=0.035) than CT recipients. The median total hospital charge for CT recipients was $6,493, compared to $20,437 for patients managed surgically (p<0.001). Delayed surgery during the index admission was associated with significantly higher total hospital charges-including operating room, room and board, radiology, and laboratory costs-than early surgery. Applying early VATS to all patients appeared more cost-efficient than delayed VATS (per-patient costs: $18,568 vs. $30,832, p<0.001), although the former had slightly higher recurrence (7.9% vs. 1.5%, p=0.08).
Variations in management strategies, particularly surgical decision-making and timing, impact hospital charges and utilization for patients with PSP.
原发性自发性气胸（PSP）的最佳治疗方法仍不明确。此外，对于各种治疗方法的总体使用情况和成本尚未完全了解。我们调查了马里兰州成年和儿科PSP患者采用不同管理策略的住院费用和资源利用情况。
我们查询了马里兰州医疗服务成本审查委员会数据库中2012年至2020年间因PSP入院的10至40岁患者。将仅接受胸腔闭式引流（CT）治疗的患者与接受电视辅助胸腔镜手术（VATS）的患者进行比较。随后，我们分析了早期VATS（入院后<48小时）与延迟VATS（≥48小时）患者的住院费用。计算了早期与延迟VATS的预计增量成本。
总体而言，共确定了354例入院病例，其中211例（59.6%）接受CT治疗，143例（40.4%）接受VATS治疗。接受VATS治疗的患者比接受CT治疗的患者更可能为女性（24%对15%，p = 0.030）和黑人（32%对20%，p = 0.035）。CT治疗患者的住院总费用中位数为6493美元，而手术治疗患者为20437美元（p<0.001）。在首次入院期间延迟手术与包括手术室、食宿、放射学和实验室费用在内的住院总费用显著高于早期手术相关。对所有患者应用早期VATS似乎比延迟VATS更具成本效益（每位患者成本：18568美元对30832美元，p<0.001），尽管前者的复发率略高（7.9%对1.5%，p = 0.08）。
管理策略的差异，尤其是手术决策和时机，会影响PSP患者的住院费用和资源利用情况。
