Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures.
Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures.
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DOI：
10.1097/sla.0000000000001590
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发表时间：
2017-03
影响因子：
9
通讯作者：
Hamilton BH
中科院分区：
文献类型：
--
作者：
Olsen MA;Tian F;Wallace AE;Nickel KB;Warren DK;Fraser VJ;Selvam N;Hamilton BH
确定手术部位感染（SSI）对整个成本分布中常见门诊手术后医疗成本的影响。门诊手术后SSI的成本数据很少，特别是平均成本之外的变化。我们对2004年12月31日至2010年12月31日期间接受胆囊切除术、保乳手术（BCS）、前交叉韧带重建术（ACL）和疝修补术的患者进行了一项回顾性队列研究，使用商业保险公司索赔数据。确定了术后90天内的SSI;住院期间的感染或需要手术的感染被认为是严重事件。我们使用分位数回归，控制患者，手术和术后因素，以检查SSI对整个成本分布的180天医疗费用的影响。21，062例ACL术后严重和非严重SSI的发生率分别为0.8%和0.2%，57，750例胆囊切除术后分别为0.5%和0.3%，60，681例疝术后分别为0.6%和0.5%，42，489例BCS术后分别为0.8%和0.8%。在整个成本分布中，对于所有4种手术，严重SSI的成本显著高于非严重SSI。胆囊切除术和疝修补术的严重SSI的可归因成本随着总成本分位数的增加而增加（在第70百分位数的成本时，胆囊切除术伴严重SSI与无SSI的成本分别为38，410美元，在第90百分位数时高达89，371美元）。SSI，特别是导致住院或手术治疗的严重感染，与4种常见手术后的医疗费用显著增加相关。分位数回归说明了严重SSI对成本分布上端医疗成本的差异影响。
To determine the impact of surgical site infections (SSIs) on healthcare costs following common ambulatory surgical procedures throughout the cost distribution. Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery (BCS), anterior cruciate ligament reconstruction (ACL), and hernia repair from 12/31/2004–12/31/2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day healthcare costs throughout the cost distribution. The incidence of serious and non-serious SSIs were 0.8% and 0.2% after 21,062 ACL, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 BCS procedures. Serious SSIs were associated with significantly higher costs than non-serious SSIs for all 4 procedures throughout the cost distribution. The attributable cost of serious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs. no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile). SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased healthcare costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on healthcare costs at the upper end of the cost distribution.