Ladant François-Xavier, Parc Yann, Roupret Morgan, Kong Edward, Ristovska Ljubica, Retbi Aurélia, Chartier Kastler Emmanuel, Assouad Jalal, Etienne Harry, Sautet Alain, Mardon Victor, Scrumeda Maxim, Diallo Abou Kane, Hedou Julien, Rufat Pierre, Verdonk Franck
Department of Economics, Harvard University, Cambridge, Massachusetts, USA.
Northwestern University, Evanston, Illinois, USA.
BMJ Surg Interv Health Technol. 2025 Mar 3;7(1):e000323. doi: 10.1136/bmjsit-2024-000323. eCollection 2025.
To quantify how surgical complications impact hospital revenue when their effect on the volume of admissions is considered.
Retrospective analysis of comprehensive administrative data.
Three university hospitals in France.
54 637 inpatient stays between 2017 and 2023 in 4 surgical departments (abdominal, orthopedics, thoracic, and urology).
Stays were categorized by their diagnosis-related group and occurrence of one or more complications, according to International Classification of Diseases, 10th revision diagnosis codes. First, data were aggregated monthly to determine the impact of variation in the monthly mean length of stay (LOS) on the monthly volume of admissions, using an instrumental variable strategy. Second, LOS and revenue per patient were compared for patients with and without complications. Finally, an estimation of the impact of complications on total revenue was performed.
A total of 54 637 stays were analyzed, with 9735 (17.8%) experiencing at least one complication. The mean LOS was 8.7 days and the mean revenue per patient was €7602. The instrumental variable analysis, designed to account for unobserved confounders, showed that a decrease of 10% in the monthly mean LOS increased the monthly volume of admissions by 9% (95% CI (5.1% to 13.0%), p<0.01). Complications increased the LOS by 10.9 days (95% CI: (8.95 to 13.1), p<0.01) and revenue per patient by €7912 (95% CI: (6420 to 9087), p<0.01), but decreased daily revenue per patient by €211 (95% CI: (-384 to -83.0), p<0.01). Over the study period, the estimated potential loss induced by complications ranged from 6.6% (95% CI (6.3% to 7.0%), p<0.01) to 9.1% (95% CI (8.8% to 9.4%), p<0.01) of actual revenue. Departments with higher complication rates incurred larger potential losses.
Surgical complications reduce total revenue by crowding out short stays that generate more daily revenue. This challenges the consensus that complications are a boon for hospital revenue, instead implying that they shrink hospital net margins (ie, revenue minus costs).
在考虑手术并发症对住院量影响的情况下，量化其对医院收入的影响。
对综合行政数据进行回顾性分析。
法国的三家大学医院。
2017年至2023年期间4个外科科室（腹部、骨科、胸科和泌尿外科）的54637例住院病例。
根据国际疾病分类第10版诊断编码，住院病例按诊断相关分组以及是否发生一种或多种并发症进行分类。首先，每月汇总数据，采用工具变量策略确定每月平均住院时间（LOS）变化对每月住院量的影响。其次，比较有并发症和无并发症患者的住院时间和每位患者的收入。最后，对并发症对总收入的影响进行估计。
共分析了54637例住院病例，其中9735例（17.8%）至少发生一种并发症。平均住院时间为8.7天，每位患者的平均收入为7602欧元。旨在考虑未观察到的混杂因素的工具变量分析表明，每月平均住院时间减少10%会使每月住院量增加9%（95%CI（5.1%至13.0%），p<0.01）。并发症使住院时间增加10.9天（95%CI：（8.95至13.1），p<0.01），每位患者的收入增加7912欧元（95%CI：（6420至9087），p<0.01），但每位患者的每日收入减少211欧元（95%CI：（-384至-83.0），p<0.01）。在研究期间，并发症导致的估计潜在损失占实际收入的6.6%（95%CI（6.3%至7.0%））至9.1%（95%CI（8.8%至9.4%），p<0.01）。并发症发生率较高的科室遭受的潜在损失更大。
手术并发症通过挤出每日收入更高的短期住院病例而降低了总收入。这对并发症对医院收入有益的共识提出了挑战，相反意味着它们会缩小医院的净利润（即收入减去成本）。
