Impact of processes of care aimed at complication reduction on the cost of complex cancer surgery.
Impact of processes of care aimed at complication reduction on the cost of complex cancer surgery.
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旨在减少并发症的护理过程对复杂癌症手术成本的影响。
DOI：
10.1002/jso.24053
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发表时间：
2015
影响因子：
2.5
通讯作者：
Aloia,ThomasA
中科院分区：
文献类型：
--
作者：
Short,MarahN;Ho,Vivian;Aloia,ThomasA
背景和目标医疗保健提供者在复杂癌症患者的护理中添加了多个流程，相信它们可以预防和/或改善并发症。然而，这些过程、并发症治疗和支出之间的关系尚不清楚。方法从医院和住院医师 2005-2009 年医疗保险报销中获得接受结肠切除术、直肠切除术、肺叶切除术、全肺切除术、食管切除术和胰腺切除术的癌症诊断患者的数据。风险调整回归分析测量了住院费用与假定预防和/或补救高风险手术常见并发症的流程之间的关联。结果在控制合并症后，分析确定了费用增加与使用多种流程之间的关联，包括动脉导管（高出 4-12%；P< 0.001）和肺动脉导管（高出 23-33%；P< 0.001）。硬膜外镇痛与较高的费用无关。会诊与费用增加 24-44% (P<0.001) 相关，全肠外营养与费用增加 13-31% 相关 (P<0.001)。结论 许多经常使用的流程和服务被认为可以避免和/或改善并发症，但与肿瘤外科费用增加相关。这表明每个过程以患者为中心的价值应在特定于程序的基础上进行衡量。同样，应进一步关注确定围手术期护理中这些昂贵但往往未经证实的附加措施的功效。外科医生。安科尔。 2015；112：610–615。 © 2015 The Authors.Journal of Surgical Oncology由 Wiley periodicals, Inc. 出版。
Background and ObjectivesHealth care providers add multiple processes to the care of complex cancer patients, believing they prevent and/or ameliorate complications. However, the relationship between these processes, complication remediation, and expenditures is unknown.MethodsData for patients with cancer diagnoses undergoing colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection were obtained from hospital and inpatient physician Medicare claims for the years 2005–2009. Risk‐adjusted regression analyses measured the association between hospitalization costs and processes presumed to prevent and/or remedy complications common to high‐risk procedures.ResultsAfter controlling for comorbidities, analysis identified associations between increased costs and use of multiple processes, including arterial lines (4–12% higher;P< 0.001) and pulmonary artery catheters (23–33% higher;P< 0.001). Epidural analgesia was not associated with higher costs. Consultations were associated with 24‐44% (P< 0.001) higher costs, and total parenteral nutrition was associated with 13–31% higher costs (P< 0.001).ConclusionsMany frequently utilized processes and services presumed to avoid and/or ameliorate complications are associated with increased surgical oncology costs. This suggests that the patient‐centered value of each process should be measured on a procedure‐specific basis. Likewise, further attention should be focused on defining the efficacy of each of these costly, but frequently unproven, additions to perioperative care.J. Surg. Oncol. 2015;112:610–615. © 2015 The Authors.Journal of Surgical OncologyPublished by Wiley Periodicals, Inc.