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減量手術:使い捨て費用は,測定可能な利益なしに外科医の変動によって引き起こされます
Ramsey M Dallal1, Marc A Neff1, Sultan S Adbelhamid1
1Sidney Kimmel Medical College, Jefferson Healthcare, Philadelphia, Pennsylvania.
まとめ
外科医の変動性は,患者のアウトカムを改善することなく,減量外科手術の費用を大幅に増加させます. 外科医の診療の最適化により,医療の質を損なうことなく,手術費用を25%以上削減できます.
科学分野:
- 医療経済学 医療経済学
- 外科手術の結果の研究
- 医療サービス 研究 医療サービス
背景:
- 手術室の費用は,病院の費用の60%を占めています.
- 外科医の変動性により,著しいコストの非効率性が想定されている.
研究 の 目的:
- 減量外科手術における処置可能な手術費用と患者の治療成果の関連性をモデル化.
- 外科医効果やロボット使用など,コストの変動に寄与する要因を特定する.
主な方法:
- 大規模な大学保健医療システムからのデータを分析するために,混合効果回帰モデルが使用されました.
- この研究では,4067の胃スリーブ,1375の胃バイパス,447の十二指管スイッチの手続きが行われました.
- 費用,ロボット使用,処置タイプ,患者要因,外科医効果との関連が評価されました.
主要な成果:
- 外科医の変動は,最大59.4%のコスト増加を占め,外科医の間で最大3305ドルの差異がありました.
- より高いコストは,より長い運用時間 (OT) と長期滞在期間 (pLOS) と相関しています.
- ロボットプラットフォームは,再入学率や再稼働率に重大な影響を及ぼさなかった. 25.4%の運用費用には,測定可能な利益がなかった.
結論:
- 処置可能な費用の実質的な外科医による変動は,改善された臨床結果と相関していません.
- 外科医特有のコストの違いに対処することによって,価値最適化のための機会が存在します.
- 外科医の間の慣行を標準化することで,減量外科手術のコストを大幅に削減することができます.
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