PDF(Sci-hub)
Abstract：
Repair of ventral and incisional hernias remains a costly challenge for health care systems. In a previous study of a single surgeon\'s elective open ventral hernia repair (VHR) practice, a cost model was developed, which predicted over 70% of hospital cost variation. The purpose of the present study was to evaluate the ventral hernia cost model with multiple surgeons\' elective open VHR cases and extending to include nonelective and laparoscopic VHR.
With the University of Kentucky Institutional Review Board approval, elective and emergent cases of open and laparoscopic VHR performed by multiple surgeons over 3 y were identified. Perioperative variables were obtained from the local American College of Surgeons National Surgery Quality Improvement Program database and electronic medical record review. Hospital cost data were obtained from the hospital cost accounting system. Forward multivariable regression of log-transformed costs identified independent cost drivers (P for entry < 0.05, and P for exit > 0.10).
Of the 387 VHRs, 74% were open repairs; mean age was 55 y, and 52% of patients were female. For open, elective cases (n = 211; mean cost of $19,145), the previously reported six-factor cost model predicted 45% of the total cost variation. With all VHRs included, additional variables were found to independently drive costs, predicting 59% of the total cost variation from the base cost. The biggest cost drivers were inpatient status (+$1013), use of biologic mesh (+$1131), preoperative systemic inflammatory response syndrome/sepsis (+$894), and preoperative open wound (+$786).
Ventral hernia repair cost variability is predictable. Understanding the independent drivers of cost may be helpful in controlling costs and in negotiating appropriate reimbursement with payers.
With the University of Kentucky Institutional Review Board approval, elective and emergent cases of open and laparoscopic VHR performed by multiple surgeons over 3 y were identified. Perioperative variables were obtained from the local American College of Surgeons National Surgery Quality Improvement Program database and electronic medical record review. Hospital cost data were obtained from the hospital cost accounting system. Forward multivariable regression of log-transformed costs identified independent cost drivers (P for entry < 0.05, and P for exit > 0.10).
Of the 387 VHRs, 74% were open repairs; mean age was 55 y, and 52% of patients were female. For open, elective cases (n = 211; mean cost of $19,145), the previously reported six-factor cost model predicted 45% of the total cost variation. With all VHRs included, additional variables were found to independently drive costs, predicting 59% of the total cost variation from the base cost. The biggest cost drivers were inpatient status (+$1013), use of biologic mesh (+$1131), preoperative systemic inflammatory response syndrome/sepsis (+$894), and preoperative open wound (+$786).
Ventral hernia repair cost variability is predictable. Understanding the independent drivers of cost may be helpful in controlling costs and in negotiating appropriate reimbursement with payers.
摘要：
腹侧和切口疝的修复对于医疗保健系统来说仍然是昂贵的挑战。在一个单一的外科医生的选择性开放腹侧疝修补术（VHR）实践的先前研究，开发了成本模型，预测超过70%的医院成本变化。本研究的目的是评估多个外科医生的腹疝成本模型，并扩展到包括非选择性和腹腔镜VHR。
经肯塔基大学机构审查委员会批准，确定了由多名外科医生进行3年以上的开腹和腹腔镜VHR的选择性和急诊病例.围手术期变量来自当地的美国外科医生学会国家外科质量改进计划数据库和电子病历审查。医院成本数据来源于医院成本核算系统。对数变换成本的正向多变量回归确定了独立的成本驱动因素（P<0.05，P>0.10）。
在387台VHR中,74%为开放式维修；平均年龄为55岁，52%的患者为女性。对于开放，选修案例(n=211；平均费用为19,145美元)，先前报告的六因素成本模型预测了总成本变化的45%。包括所有VHR，发现了额外的变量来独立驱动成本，从基本成本预测总成本变化的59%。最大的成本驱动因素是住院状况(+1013美元)，使用生物网(+1131美元)，术前全身炎症反应综合征/脓毒症（+894美元），和术前开放性伤口（+$786）。
腹侧疝修补术成本差异是可预测的。了解成本的独立驱动因素可能有助于控制成本并与付款人协商适当的报销。
经肯塔基大学机构审查委员会批准，确定了由多名外科医生进行3年以上的开腹和腹腔镜VHR的选择性和急诊病例.围手术期变量来自当地的美国外科医生学会国家外科质量改进计划数据库和电子病历审查。医院成本数据来源于医院成本核算系统。对数变换成本的正向多变量回归确定了独立的成本驱动因素（P<0.05，P>0.10）。
在387台VHR中,74%为开放式维修；平均年龄为55岁，52%的患者为女性。对于开放，选修案例(n=211；平均费用为19,145美元)，先前报告的六因素成本模型预测了总成本变化的45%。包括所有VHR，发现了额外的变量来独立驱动成本，从基本成本预测总成本变化的59%。最大的成本驱动因素是住院状况(+1013美元)，使用生物网(+1131美元)，术前全身炎症反应综合征/脓毒症（+894美元），和术前开放性伤口（+$786）。
腹侧疝修补术成本差异是可预测的。了解成本的独立驱动因素可能有助于控制成本并与付款人协商适当的报销。
