Rekhtman David, Brown Danielle E, Hwang Jasmine, Sharpe James, Rosenthal J Walker, Finn Caitlin, Fraker Douglas, Kelz Rachel
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Ann Surg Oncol. 2025 Jul 22. doi: 10.1245/s10434-025-17699-7.
To minimize complications after parathyroidectomy, it is critical to connect patients with facilities equipped to perform this specialized procedure. This study assessed the effect of "referring" patients to higher-performing facilities for parathyroidectomy.
A simulation study of adults who underwent parathyroidectomy for primary hyperparathyroidism was conducted using the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery and Services databases. Wilson score estimates were used to generate serious adverse event (SAE) rates for a training cohort to divide surgical facilities into quality quartiles. Using each facility's fixed effect from the regression model, this study simulated the difference in SAE and cost for each patient between treatment at their original facility and treatment at an alternative higher-quality facility based on a lower SAE rate. The set of potential alternative facilities was determined based on proximity or original facility health system affiliation.
Of the 14,738 patients included in the proximity analysis 11,733 were randomized to the training group and 3005 to the testing cohort. The baseline characteristics and outcomes did not differ between the cohorts. Among the patients in the testing cohort, 314 were simulated to receive care at a higher-quality facility. The simulation predicted decreased SAE rates (2% vs. 3%; p < 0.001), with slightly increased total cost ($6391 vs. $6,351; p = 0.032). The results in the two simulations were similar.
Simulation indicated that data-driven parathyroidectomy referrals can reduce SAE and advance surgical health equity. Data-driven facility selection is one way to achieve better surgical outcomes.
为了尽量减少甲状旁腺切除术后的并发症，将患者与具备进行这一专业手术设施的机构建立联系至关重要。本研究评估了将患者“转诊”至甲状旁腺切除术表现更佳机构的效果。
利用医疗成本与利用项目的州住院患者、门诊手术及服务数据库，对因原发性甲状旁腺功能亢进接受甲状旁腺切除术的成年人进行了一项模拟研究。采用威尔逊评分估计值来生成训练队列的严重不良事件（SAE）发生率，以便将手术机构划分为质量四分位数。基于较低的SAE发生率，利用回归模型中每个机构的固定效应，本研究模拟了每位患者在其原机构治疗与在替代的更高质量机构治疗之间SAE和成本的差异。潜在替代机构的集合是根据距离或原机构的卫生系统隶属关系确定的。
在纳入距离分析的14738例患者中，11733例被随机分配至训练组，3005例被分配至测试队列。各队列的基线特征和结局无差异。在测试队列的患者中，模拟有314例在更高质量的机构接受治疗。模拟预测SAE发生率降低（2%对3%；p<0.001），总成本略有增加（6391美元对6351美元；p=0.032）。两次模拟的结果相似。
模拟表明，数据驱动的甲状旁腺切除术转诊可降低SAE并促进手术健康公平性。数据驱动的机构选择是实现更好手术结局的一种方式。
