Effect of Laparoscopic Surgery on Health Care Utilization and Costs in Patients Who Undergo Colectomy
Effect of Laparoscopic Surgery on Health Care Utilization and Costs in Patients Who Undergo Colectomy
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DOI：
10.1001/jamasurg.2014.3171
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发表时间：
2015-05-01
期刊：
影响因子：
16.9
通讯作者：
Delaney, Conor P.
中科院分区：
文献类型：
--
作者：
Crawshaw, Benjamin P.;Chien, Hung-Lun;Delaney, Conor P.
腹腔镜结肠切除术是治疗多种结直肠疾病的安全有效的方法。然而，腹腔镜手术的增加对整体卫生保健利用和费用的影响，特别是在长期内，还没有得到彻底的调查。目的评价腹腔镜与开腹结肠切除术对短期和长期卫生保健利用和费用的影响。和参与者国家健康保险索赔数据的回顾性多元回归分析被用来评估卫生保健利用和择期结肠切除术后1年的费用。数据来自Truven Health Analytics MarketScan Commercial Claims and Encounters数据库。纳入2010年1月1日至2010年12月31日期间接受择期腹腔镜或开放性结肠切除术的18 - 64岁患者。排除了需要增加非手术相关医疗保健利用的复杂诊断患者，包括恶性肿瘤、炎症性肠病、人类免疫缺陷病毒、移植和妊娠。在25481例接受结肠切除术的患者中，有4160例被纳入研究。主要结果和测量：医疗利用，包括门诊、医院门诊、急诊和住院服务，术后90天和365天;结果25481例结肠切除术患者中，4160例纳入研究腹腔镜手术45.6%;开腹手术54.4%。腹腔镜手术的平均（SD）净支付和总支付较低（23 064美元[14 558美元]和24 196美元[14 507美元] vs 29 753美元[21 421美元]和31 606美元[23 586美元]）。在手术后的前90天内，开放手术与医疗保健费用增加1.26倍（估计为1715美元; 95%CI，338- 2853美元）、医疗保健服务使用增加以及估计的休假天数增加（2.78天; 95%CI，1.93-3.59）显著相关。在术后一年中发现了类似的趋势，估计增加了1.18倍（95% CI，1.04-1.35），医疗保健支出增加1.15倍（95%可信区间，（1.08-1.23）结论和相关性腹腔镜结肠切除术的结果在显着减少医疗保健费用，术后短期和长期的使用。
IMPORTANCE Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated.OBJECTIVE To evaluate the effect of laparoscopic vs open colectomy on short-and long-term health care utilization and costs.DESIGN, SETTING, AND PARTICIPANTS Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study.MAIN OUTCOMES AND MEASURES Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization.RESULTS Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($ 23 064 [$ 14 558] and $ 24 196 [$ 14 507] vs $ 29 753 [$ 21 421] and $ 31 606 [$ 23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $ 1715; 95% CI, $ 338-$ 2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy.CONCLUSIONS AND RELEVANCE Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short-and long-term postoperative periods.