A Comparison of Length of Stay, Readmission Rate, and Facility Reimbursement After Lobectomy of the Lung
A Comparison of Length of Stay, Readmission Rate, and Facility Reimbursement After Lobectomy of the Lung
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DOI：
10.1016/j.athoracsur.2013.06.053
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发表时间：
2013-11-01
影响因子：
4.6
通讯作者：
Mahidhara, Raja S.
中科院分区：
文献类型：
--
作者：
Freeman, Richard K.;Dilts, J. Russell;Mahidhara, Raja S.
背景重新入院已成为支付者关注的焦点，因为可预防的重新入院可能会导致不支付费用，而且重新入院率过高可能会受到全球惩罚。本研究比较了接受肺叶切除术患者的再入院率和住院时间（LOS）以及对报销的潜在影响。单一卫生系统医院的Premier数据库用于确定心胸外科医生在5年内接受非小细胞肺癌肺叶切除术的患者。还计算了Charlson合并症评分。回归分析被用来研究住院时间和再入院率之间的关系。还比较了LOS和再入院对报销的影响。在研究期间，在医疗保健系统内的61家医院进行了4，296例肺叶切除术，这些医院符合研究的入选标准。记录了289例患者（7%）的再入院。与再入院相关的因素是住院时间少于5天或超过16天，年龄超过78岁（p = 0.001）。LOS和再入院对报销的影响分析发现，延长LOS比再入院更具成本效益。该综述发现，肺叶切除术后的平均LOS与再入院率呈负相关，最大影响发生在术后第5天之前。此外，在延长服务时间时，设施补偿得到了优化，以尽量减少再入院的风险。(C)2013年由胸外科医师协会
Background. Readmission to the hospital has become a focus for payers with the threat of nonpayment for preventable readmissions and a global penalty for excessive readmissions rates. This study compares readmission rates with lengths of stay (LOS) for patients undergoing lobectomy of the lung and the potential impact on reimbursement.Methods. The Premier database for a single health system's hospitals was used to identify patients undergoing lobectomy for non-small cell lung cancer by cardiothoracic surgeons over a 5-year period. Charlson comorbidity scores were also calculated. Regression analysis was used to study the relationship between length of stay and readmission rates. A comparison of the effects of LOS and readmission on reimbursement was also performed.Results. During the study period, 4,296 lobectomies were performed in 61 hospitals within the healthcare system that met the study's inclusion criteria. A readmission was recorded for 289 patients (7%). Factors associated with readmission were length of stay less than 5 days or more than 16 days and age more than 78 years (p = 0.001). An analysis of the effects of LOS and readmission on reimbursement found an extension of LOS was more cost effective than a readmission.Conclusions. This review found that mean LOS after lobectomy is negatively associated with readmission rates, with the maximal effect being before postoperative day 5. Furthermore, facility reimbursement was optimized when LOS was extended to minimize the risk of readmission. (C) 2013 by The Society of Thoracic Surgeons