PDF(Pubmed)
Abstract：
BACKGROUND: Literature regarding the impact of esophagectomy approach on hospitalizations costs and short-term outcomes is limited. Moreover, few have examined how institutional MIS experience affects costs. We thus examined utilization trends, costs, and short-term outcomes of open and minimally invasive (MIS) esophagectomy as well as assessing the relationship between institutional MIS volume and hospitalization costs.
METHODS: All adults undergoing elective esophagectomy were identified from the 2016-2020 Nationwide Readmissions Database. Multiple regression models were used to assess approach with costs, in-hospital mortality, and major complications. Additionally, annual hospital MIS esophagectomy volume was modeled as a restricted cubic spline against costs. Institutions performing > 16 cases/year corresponding with the inflection point were categorized as high-volume hospitals (HVH). We subsequently examined the association of HVH status with costs, in-hospital mortality, and major complications in patients undergoing minimally invasive esophagectomy.
RESULTS: Of an estimated 29,116 patients meeting inclusion, 10,876 (37.4%) underwent MIS esophagectomy. MIS approaches were associated with $10,600 in increased incremental costs (95% CI 8,800-12,500), but lower odds of in-hospital mortality (AOR 0.76; 95% CI 0.61-0.96) or major complications (AOR 0.68; 95% CI 0.60, 0.77). Moreover, HVH status was associated with decreased adjusted costs, as well as lower odds of postoperative complications for patients undergoing MIS operations.
CONCLUSIONS: In this nationwide study, MIS esophagectomy was associated with increased hospitalization costs, but improved short-term outcomes. In MIS operations, cost differences were mitigated by volume, as HVH status was linked with decreased costs in the setting of decreased odds of complications. Centralization of care to HVH centers should be considered as MIS approaches are increasingly utilized.
METHODS: All adults undergoing elective esophagectomy were identified from the 2016-2020 Nationwide Readmissions Database. Multiple regression models were used to assess approach with costs, in-hospital mortality, and major complications. Additionally, annual hospital MIS esophagectomy volume was modeled as a restricted cubic spline against costs. Institutions performing > 16 cases/year corresponding with the inflection point were categorized as high-volume hospitals (HVH). We subsequently examined the association of HVH status with costs, in-hospital mortality, and major complications in patients undergoing minimally invasive esophagectomy.
RESULTS: Of an estimated 29,116 patients meeting inclusion, 10,876 (37.4%) underwent MIS esophagectomy. MIS approaches were associated with $10,600 in increased incremental costs (95% CI 8,800-12,500), but lower odds of in-hospital mortality (AOR 0.76; 95% CI 0.61-0.96) or major complications (AOR 0.68; 95% CI 0.60, 0.77). Moreover, HVH status was associated with decreased adjusted costs, as well as lower odds of postoperative complications for patients undergoing MIS operations.
CONCLUSIONS: In this nationwide study, MIS esophagectomy was associated with increased hospitalization costs, but improved short-term outcomes. In MIS operations, cost differences were mitigated by volume, as HVH status was linked with decreased costs in the setting of decreased odds of complications. Centralization of care to HVH centers should be considered as MIS approaches are increasingly utilized.
摘要：
背景：关于食管切除术对住院费用和短期预后影响的文献有限。此外，很少有人研究机构管理信息系统经验如何影响成本。因此，我们检查了利用率趋势，成本,和开放和微创（MIS）食管切除术的短期结果，以及评估机构MIS体积和住院费用之间的关系。
方法：从2016-2020年全国再入院数据库中确定所有接受择期食管切除术的成年人。多元回归模型用于评估带成本的方法，住院死亡率，和主要并发症。此外,每年的医院MIS食管切除术体积被建模为对照成本的有限三次样条.与拐点对应的>16例/年的机构被归类为高容量医院(HVH)。我们随后检查了HVH状态与成本的关联，住院死亡率，以及接受微创食管切除术的患者的主要并发症。
结果：估计有29,116名符合纳入标准的患者，10,876例(37.4%)行MIS食管切除术。管理信息系统方法与增加的10,600美元增量成本相关(95%CI8,800-12,500)，但住院死亡率(AOR0.76;95%CI0.61-0.96)或主要并发症(AOR0.68;95%CI0.60,0.77)的几率较低。此外，HVH状态与调整后成本下降有关，以及接受MIS手术的患者术后并发症的可能性较低。
结论：在这项全国性的研究中，MIS食管切除术与住院费用增加有关，但改善了短期结果。在MIS操作中，成本差异按数量减少，在并发症发生率降低的情况下,HVH状态与费用降低相关.随着越来越多地使用MIS方法，应考虑将护理集中到HVH中心。
方法：从2016-2020年全国再入院数据库中确定所有接受择期食管切除术的成年人。多元回归模型用于评估带成本的方法，住院死亡率，和主要并发症。此外,每年的医院MIS食管切除术体积被建模为对照成本的有限三次样条.与拐点对应的>16例/年的机构被归类为高容量医院(HVH)。我们随后检查了HVH状态与成本的关联，住院死亡率，以及接受微创食管切除术的患者的主要并发症。
结果：估计有29,116名符合纳入标准的患者，10,876例(37.4%)行MIS食管切除术。管理信息系统方法与增加的10,600美元增量成本相关(95%CI8,800-12,500)，但住院死亡率(AOR0.76;95%CI0.61-0.96)或主要并发症(AOR0.68;95%CI0.60,0.77)的几率较低。此外，HVH状态与调整后成本下降有关，以及接受MIS手术的患者术后并发症的可能性较低。
结论：在这项全国性的研究中，MIS食管切除术与住院费用增加有关，但改善了短期结果。在MIS操作中，成本差异按数量减少，在并发症发生率降低的情况下,HVH状态与费用降低相关.随着越来越多地使用MIS方法，应考虑将护理集中到HVH中心。
