Hansen Adam J, Hayanga J W Awori, Toker Alper, Badhwar Vinay
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
JTCVS Open. 2024 Sep 26;22:485-490. doi: 10.1016/j.xjon.2024.09.022. eCollection 2024 Dec.
To evaluate the healthcare costs associated with unresolved slipping rib syndrome (SRS).
Data pertaining to patients who underwent operative repair for SRS at our academic institution were analyzed retrospectively. Duration of symptoms, previous management efforts, number of healthcare provider consultations, imaging studies, adjunctive surgical and pain management procedures performed to treat the symptoms, and prior unsuccessful SRS operations were catalogued. US Medicare billing standards were used to average costs for provider visits and overall cost of surgical and interventional pain management procedures. Analgesic medication costs were determined using generic pricing.
Between February 2019 and January 2024, a total of 435 consecutive patients spent a median of 36 months searching for a diagnosis and symptom relief prior to evaluation at our institution. The median number of physicians consulted was 6 (range, 0-75). The total cost of physician visits was $2,990,434 USD. The median number of imaging studies was 5 (range, 0-55), at a total cost of $965,949. Cholecystectomy was performed in 47 patients (11%), at a cost of $716,750. Previous SRS surgery had been attempted 150 times at various institutions and accounted for $4,500,000 (estimated $30,000 per operation in billing). Intercostal nerve block, ablation, and spinal cord stimulator placement had been performed in 30%, 15%, and 5% of the patients, respectively, at a total cost of $963,821. The median number of analgesic medications used per patient was 1 (mean, 1.3; range, 0-5); the total medication cost was $1,111,860. The total preoperative healthcare cost in our series was $12,445,173, for an average of $28,610 per patient.
SRS remains poorly understood. Symptoms can be severe and debilitating, and patients frequently consume significant healthcare resources. With recognition and definitive surgical management, SRS may be addressed successfully. Prompt treatment has the potential for significant healthcare savings.
评估与未解决的滑动肋综合征（SRS）相关的医疗费用。
对在我们学术机构接受SRS手术修复的患者数据进行回顾性分析。记录症状持续时间、先前的治疗措施、医疗服务提供者会诊次数、影像学检查、为治疗症状而进行的辅助手术和疼痛管理程序，以及先前未成功的SRS手术。采用美国医疗保险计费标准计算医疗服务提供者就诊的平均费用以及手术和介入性疼痛管理程序的总费用。使用通用定价确定镇痛药物费用。
2019年2月至2024年1月期间，共有435例连续患者在到我们机构评估之前，平均花费36个月寻找诊断和缓解症状的方法。会诊医生的中位数为6名（范围为0 - 75名）。医生就诊的总费用为2,990,434美元。影像学检查的中位数为5次（范围为0 - 55次），总费用为965,949美元。47例患者（11%）接受了胆囊切除术，费用为716,750美元。先前在不同机构尝试进行SRS手术150次，费用为4,500,000美元（计费估计每次手术30,000美元）。分别有30%、15%和5%的患者接受了肋间神经阻滞、消融和脊髓刺激器置入，总费用为963,821美元。每位患者使用镇痛药物的中位数为1种（平均为1.3种；范围为0 - 5种）；药物总费用为1,111,860美元。我们系列中的术前总医疗费用为12,445,173美元，平均每位患者28,610美元。
SRS仍然了解不足。症状可能严重且使人衰弱，患者经常消耗大量医疗资源。通过识别和明确的手术管理，SRS可能得到成功解决。及时治疗有可能显著节省医疗费用。
