The influence of complications on the costs of complex cancer surgery.
The influence of complications on the costs of complex cancer surgery.
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DOI：
10.1002/cncr.28527
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发表时间：
2014-04-01
期刊：
影响因子：
6.2
通讯作者：
Ho, Vivian
中科院分区：
文献类型：
--
作者：
Short, Marah N.;Aloia, Thomas A.;Ho, Vivian
众所周知，癌症手术后的结果差异很大，这取决于患者、肿瘤、新辅助治疗和提供者因素之间的相互作用。在这种复杂的环境中，并发症对肿瘤外科治疗费用的影响仍然未知。作者检查了6例癌症手术的患者安全指标（PSI）发生率及其与护理费用的相关性。美国医疗保健研究和质量局（AHRQ）PSI定义用于识别Medicare索赔数据中的患者安全相关并发症。分析了2005年至2009年6种癌症切除术的住院和住院医生索赔：结肠切除术、直肠切除术、肺叶切除术、肺切除术、食管切除术和胰腺切除术。风险调整回归分析用于衡量每个PSI和住院费用之间的关联。总体PSI率范围从术后髋部骨折的0.01%到呼吸衰竭的2.58%。在所有6例癌症手术中，住院患者的严重可治疗并发症、术后呼吸衰竭、术后血栓栓塞和意外穿刺/撕裂的死亡率均>1%。对于大多数癌症手术类型，几种PSI（包括褥疮、外科住院患者的死亡和严重可治疗并发症）使住院费用增加≥20%。术后呼吸衰竭导致所有癌症切除术的成本增加>50%。与癌症手术PSI相关的持续较高的成本表明，通过针对这些指标进行质量改进，可以实现大量的医疗保健节省。
It is widely known that outcomes after cancer surgery vary widely, depending on interactions between patient, tumor, neoadjuvant therapy, and provider factors. Within this complex milieu, the influence of complications on the cost of surgical oncology care remains unknown. The authors examined rates of Patient Safety Indicator (PSI) occurrence for 6 cancer operations and their association with costs of care. The Agency for Healthcare Research and Quality (AHRQ) PSI definitions were used to identify patient safety-related complications in Medicare claims data. Hospital and inpatient physician claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Risk-adjusted regression analyses were used to measure the association between each PSI and hospitalization costs. Overall PSI rates ranged from a low of 0.01% for postoperative hip fracture to a high of 2.58% for respiratory failure. Death among inpatients with serious treatable complications, postoperative respiratory failure, postoperative thromboembolism, and accidental puncture/laceration were >1% for all 6 cancer operations. Several PSIs—including decubitus ulcer, death among surgical inpatients with serious treatable complications, and postoperative thromboembolism—raised hospitalization costs by ≥20% for most cancer surgery types. Postoperative respiratory failure resulted in a cost increase >50% for all cancer resections. The consistently higher costs associated with cancer surgery PSIs indicate that substantial health care savings could be achieved by targeting these indicators for quality improvement.
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影响因子：
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作者：
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