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减肥手术:一次性成本是由外科医生的变化驱动的,没有可衡量的好处
Ramsey M Dallal1, Marc A Neff1, Sultan S Adbelhamid1
1Sidney Kimmel Medical College, Jefferson Healthcare, Philadelphia, Pennsylvania.
概括
外科医生的变化大大增加了减肥手术的成本,但没有改善患者的治疗结果. 优化外科医生实践可以在不影响护理质量的情况下,将手术费用降低25%以上.
科学领域:
- 医疗保健经济学 医疗保健经济学
- 手术结果研究研究.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 手术室费用占医院开支的60%.
- 由于外科医生的变性,假设存在重大成本低效.
研究的目的:
- 在减肥手术中建模一次性手术成本与患者结果之间的关联.
- 确定导致成本变化的因素,包括外科医生效应和机器人使用.
主要方法:
- 混合效应回归模型用于分析来自大型大学医疗保健系统的数据.
- 这项研究包括4067次胃外套,1375次胃绕道和447次十二指肠切换手术.
- 评估了成本,机器人使用,手术类型,患者因素和外科医生影响之间的关联.
主要成果:
- 外科医生的变化占成本增加的高达59.4%,外科医生之间的差异高达3305美元.
- 较高的成本与较长的操作时间 (OT) 和延长的停留时间 (pLOS) 相关联.
- 机器人平台没有显著影响再接收或重新运营率;25.4%的运营费用缺乏可衡量的收益.
结论:
- 可支配成本的实质性外科医生驱动的变化与改善的临床结果无关.
- 有机会通过解决外科医生特定的成本差异来优化价值.
- 外科医生的标准化实践可以在减肥手术中节省大量的成本.
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