Impact of the operating physician on costs of percutaneous transluminal coronary angioplasty.
Impact of the operating physician on costs of percutaneous transluminal coronary angioplasty.
复制标题
手术医生对经皮冠状动脉腔内成形术费用的影响。
DOI：
10.1016/s0002-9149(96)00157-9
复制
发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Browner,WS
中科院分区：
文献类型：
--
作者：
Heidenreich,PA;Chou,TM;Amidon,TM;Ports,TA;Browner,WS
回顾一所大学医院250例连续入院接受经皮冠状动脉腔内成形术（PTCA）的病历和账单记录。记录每例患者的临床特征、执行医生、扩张病变的血管造影特征、手术结局、住院时间以及总住院费用和科室住院费用。我们确定了医院成本的几个独立预测因素，包括医生（从最高成本到最低成本医生增加4，400美元，p = 0.004），年龄（年龄每增加10岁增加790美元，p = 0.002），手术的紧迫性（急诊与择期相比增加4，100美元，p < 0.001），联合血管造影和PTCA（与单独血管造影相比增加850美元，p = 0.04）。导管插入实验室费用的独立预测因素包括医生（从最高费用医生到最低费用医生增加1，280美元，p = 0.03），美国心脏病学会/美国心脏协会病变类型B2或C（增加320美元，p = 0.03），以及血管造影和PTCA联合（增加430美元，p = 0.003）。昂贵的操作员使用更多的导管室资源比廉价的操作员，但是，有没有显着差异的成功率或需要紧急搭桥手术的医生之间。经皮冠状动脉腔内成形术的费用取决于患者的特点和执行医生。由于医生而导致的成本增加不能用患者变量、病变特征、成功率或并发症来解释。
The hospital charts and billing records of 250 consecutive admissions for percutaneous transluminal coronary angioplasty (PTCA) at a university hospital were reviewed. Clinical characteristics, performing physician, angiographic features of the dilated lesion, procedural outcome, length of stay, and total and departmental hospital costs were recorded for each patient. We identified several independent predictors of hospital cost, including the physician ($4,400 increase from highest- to lowest-cost physician, p = 0.004), age ($790 increase per 10-year increase in age, p = 0.002), urgency of the procedure ($4,100 increase for urgent vs elective, p < 0.001), and combined angiography and PTCA ($850 increase vs separate angiography, p = 0.04). Independent predictors of catheterization laboratory cost included the physician ($1,280 increase from highest- to lowest-cost physician, p = 0.03), American College of Cardiology/American Heart Association lesion type B2 or C ($320 increase, p = 0.03), and combined angiography and PTCA ($430 increase, p = 0.003). Expensive operators used more catheterization laboratory resources than inexpensive operators; however, there were no significant differences in success rate or need for emergent bypass surgery between physicians. PTCA cost is determined by both patient characteristics and the performing physician. The increase in cost due to the physician was not explained by patient variables, lesion characteristics, success rate, or complications.