Anesthesia Service Use During Outpatient Gastroenterology Procedures Continued to Increase From 2010 to 2013 and Potentially Discretionary Spending Remained High
Anesthesia Service Use During Outpatient Gastroenterology Procedures Continued to Increase From 2010 to 2013 and Potentially Discretionary Spending Remained High
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DOI：
10.1038/ajg.2016.266
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发表时间：
2017-02-01
影响因子：
9.8
通讯作者：
Liu, Hangsheng
中科院分区：
文献类型：
--
作者：
Predmore, Zachary;Nie, Xiaoyu;Liu, Hangsheng
目的：先前的研究已发现越来越多的胃肠病学 (GI) 手术使用麻醉服务来提供镇静，其中大多数服务提供给低风险患者。本研究的目的是用最近几年的数据更新这些趋势。 方法：我们使用 2010 年至 2013 年的医疗保险和商业索赔数据来识别基于 CPT 代码的胃肠道手术和麻醉服务，这些代码使用患者标识符和服务日期链接在一起。我们将低风险患者定义为 ASA（美国麻醉医师协会）身体状况 I 级或 II 级的患者。对于索赔中未列出 ASA 类别的患者，我们使用预测算法来估算 ASA 身体状况。 结果：我们的样本中有超过 660 万患者在 2010 年至 2013 年间接受过胃肠道手术。在 Medicare 患者中，2010 年和 2013 年涉及麻醉服务的胃肠道手术分别占 33.7% 和 47.6%，2010 年和 2013 年为 38.3%。 2013 年，有商业保险的患者中这一比例为 53.0%。总体而言，随着越来越多的患者使用麻醉服务，低风险患者的麻醉服务使用总数增加了 14%，从每百万 Medicare 参保者中的 27,191 人增加到 33,181 人。同样，我们观察到商业保险患者的数量几乎相同，从每百万 15,871 人增加到 22,247 人，增加了近 15%。 2010 年至 2013 年期间，低风险患者的麻醉服务相关支出从每百万医疗保险参保者的 314 万美元增加到 345 万美元，每百万商业保险患者的麻醉服务支出从每百万名商业保险患者的 769 万美元增加到 1066 万美元。结论：2010 年至 2013 年期间，胃肠道手术中麻醉服务的使用持续增加，且麻醉服务的比例持续增加。为低风险患者提供的服务仍然很高。
OBJECTIVES: Previous studies have identifi ed an increasing number of gastroenterology (GI) procedures using anesthesia services to provide sedation, with a majority of these services delivered to low-risk patients. The aim of this study was to update these trends with the most recent years of data.METHODS: We used Medicare and commercial claims data from 2010 to 2013 to identify GI procedures and anesthesia services based on CPT codes, which were linked together using patient identifi ers and dates of service. We defi ned low-risk patients as those who were classifi ed as ASA (American Society of Anesthesiologists) physical status class I or II. For those patients without an ASA class listed on the claim, we used a prediction algorithm to impute an ASA physical status.RESULTS: Over 6.6 million patients in our sample had a GI procedure between 2010 and 2013. GI procedures involving anesthesia service accounted for 33.7% in 2010 and 47.6% in 2013 in Medicare patients, and 38.3% in 2010 and 53.0% in 2013 in commercially insured patients. Overall, as more patients used anesthesia services, total anesthesia service use in low-risk patients increased 14%, from 27,191 to 33,181 per million Medicare enrollees. Similarly, we observed a nearly identical uptick in commercially insured patients from 15,871 to 22,247 per million, an increase of almost 15%. During 2010-2013, spending associated with anesthesia services in low-risk patients increased from US$ 3.14 million to US$ 3.45 million per million Medicare enrollees and from US$ 7.69 million to US$ 10.66 million per million commercially insured patients.CONCLUSIONS: During 2010 to 2013, anesthesia service use in GI procedures continued to increase and the proportion of these services rendered for low-risk patients remained high.