Abstract：
OBJECTIVE: Traditional hospital accounting fails to provide an accurate cost of complex surgical care. Here we describe the application of time-driven activity-based costing (TDABC) to characterize costs of head and neck oncologic procedures involving free tissue transfer.
METHODS: Retrospective cohort study.
METHODS: Single tertiary academic medical center.
METHODS: An analysis of head and neck oncologic procedures involving microvascular free flap reconstruction from 2018 to 2020 (n = 485) was performed using TDABC methodology to measure cost across operative case and postoperative admission, using quantity of time and cost per unit of each resource to characterize resource utilization. Univariate and generalized linear mixed models were used to examine associations between patient and hospital characteristics and cost of care delivery.
RESULTS: The total cost of care delivery was $41,905.77 ± 21,870.27 with operating room (OR) supplies accounting for only 10% of the total cost. Multivariable analyses identified significant cost drivers including operative time, postoperative length of stay, number of return trips to the OR, postoperative complication, number of free flaps performed, and patient transfer from another hospital or via emergency department admission (P < .05).
CONCLUSIONS: Operative time and postoperative length of stay, but not operative supplies, were primary drivers of cost of care for head and neck oncology cases involving free tissue transfer. TDABC offers granular cost characterization to inform cost optimization through unused capacity identification and postoperative admission efficiencies.
METHODS: Retrospective cohort study.
METHODS: Single tertiary academic medical center.
METHODS: An analysis of head and neck oncologic procedures involving microvascular free flap reconstruction from 2018 to 2020 (n = 485) was performed using TDABC methodology to measure cost across operative case and postoperative admission, using quantity of time and cost per unit of each resource to characterize resource utilization. Univariate and generalized linear mixed models were used to examine associations between patient and hospital characteristics and cost of care delivery.
RESULTS: The total cost of care delivery was $41,905.77 ± 21,870.27 with operating room (OR) supplies accounting for only 10% of the total cost. Multivariable analyses identified significant cost drivers including operative time, postoperative length of stay, number of return trips to the OR, postoperative complication, number of free flaps performed, and patient transfer from another hospital or via emergency department admission (P < .05).
CONCLUSIONS: Operative time and postoperative length of stay, but not operative supplies, were primary drivers of cost of care for head and neck oncology cases involving free tissue transfer. TDABC offers granular cost characterization to inform cost optimization through unused capacity identification and postoperative admission efficiencies.
摘要：
目的：传统的医院会计无法提供复杂外科护理的准确成本。在这里，我们描述了时间驱动的基于活动的成本计算（TDABC）的应用，以表征涉及自由组织转移的头颈部肿瘤手术的成本。
方法：回顾性队列研究。
方法：单一三级学术医学中心。
方法：使用TDABC方法对2018年至2020年涉及微血管游离皮瓣重建的头颈部肿瘤手术进行了分析（n=485），以测量手术病例和术后入院的成本。使用每单位资源的时间和成本来表征资源利用率。使用单变量和广义线性混合模型来检查患者和医院特征与护理交付成本之间的关联。
结果：提供护理的总费用为$41,905.77±21,870.27，手术室（OR）用品仅占总费用的10％。多变量分析确定了重要的成本驱动因素，包括手术时间、术后住院时间,返回OR的次数，术后并发症,执行的自由襟翼数量，和患者从另一家医院转移或通过急诊科入院（P<0.05）。
结论：手术时间和术后住院时间，但不是手术用品，是涉及免费组织转移的头颈部肿瘤病例护理费用的主要驱动因素.TDABC提供了细粒度的成本表征，通过未使用的容量识别和术后入院效率来告知成本优化。
方法：回顾性队列研究。
方法：单一三级学术医学中心。
方法：使用TDABC方法对2018年至2020年涉及微血管游离皮瓣重建的头颈部肿瘤手术进行了分析（n=485），以测量手术病例和术后入院的成本。使用每单位资源的时间和成本来表征资源利用率。使用单变量和广义线性混合模型来检查患者和医院特征与护理交付成本之间的关联。
结果：提供护理的总费用为$41,905.77±21,870.27，手术室（OR）用品仅占总费用的10％。多变量分析确定了重要的成本驱动因素，包括手术时间、术后住院时间,返回OR的次数，术后并发症,执行的自由襟翼数量，和患者从另一家医院转移或通过急诊科入院（P<0.05）。
结论：手术时间和术后住院时间，但不是手术用品，是涉及免费组织转移的头颈部肿瘤病例护理费用的主要驱动因素.TDABC提供了细粒度的成本表征，通过未使用的容量识别和术后入院效率来告知成本优化。
